Supracondylar periprosthetic femoral fractures following total knee arthroplasty: treatment with a retrograde intramedullary nail

Abstract

Total knee replacement surgery is occasionally complicated by a supracondylar periprosthetic fracture, and this presents a challenging problem in an often frail population. Multiple nonoperative and operative treatments have been described which have the aim of restoring the patient to their pre-injury status. This study retrospectively reviews the results of the largest series to date of 14 such fractures treated by retrograde intramedullary supracondylar nailing and is supportive of its continued use with good functional outcomes, low complication rates, and 100% fracture union.Résumé Les prothèses totales du genou peuvent être occasionnellement compliquées par une fracture supra condylienne. De nombreuses méthodes thérapeutiques ont été décrites avec le but de restaurer l'état des patients avant la fracture. Une étude rétrospective sur une très large série de 14 fractures traitées par clous intramédullaires rétro-grades ont permis de mettre en évidence un devenir fonctionnel et un taux de complications très bas ainsi qu'un taux de consolidation de 100%.

Fixation of Periprosthetic Femur Fractures Above Total Knee Arthroplasty With the Less Invasive Stabilization System: A Midterm Follow-Up Study

“…14,23,54,58 -60 In one comparative clinical study between the LISS and the retrograde nail, 11% of the intramedullary implants failed. 36 Chettiar et al 61 retrospectively reviewed the results of 14 supracondylar periprosthetic fractures treated by retrograde intramedullary nailing and found good functional outcomes, low complications rates, and 100% fracture union. In another study, one LISS (20%) with a flexion deformity of 16°f ailed.…”

Extension Malunion of the Femoral Component After Retrograde Nailing

“…They concluded that the retrograde nail should be considered the treatment of choice for type I and II SFF above TKA. Weber et al, 14 Chettiar et al, 17 and Chen et al 16 retrospectively reviewed patients with SFF above TKA and reported limited complications and good functional and radiological outcomes. However, El-Kawy et al 8 considered the high incidence of TKA malalignment in an elderly population with intra-articular SFF (without TKA) a contraindication for retrograde nailing.…”

Fixation of Periprosthetic Supracondylar Femur Fractures Above Total Knee Arthroplasty – The Indirect Reduction Technique with the Condylar Blade Plate and the Minimally Invasive Technique with the LISS

“…Angular correction and additional stability can be achieved bx placing blocking screws in the distal fragment (Stedtfeld et al, 2004). In a retrospective study, 14 supracondylar periprosthetic fractures obtained good functional outcomes, a low complication rate and 100% fracture unions (Chettiar et al, 2009). …”

“…Numerous studies (Chettiar et al, 2009;Gliatis et al, 2005;Henry, 1995;Murrell & Nunley, 1995;Platzer et al, 2010;Rolston et al, 1995;Smith et al, 1996) recommend nailing in the posterior cruciate ligament retaining femoral component with an open box. The supracondylar nail preserves the fracture haematoma, does not require extensive soft-tissue stripping, and provides fair stability to the fracture (Figgie et al, 1990;Gardner et al, 2004;Gliatis et al, 2005;Kolb et al, 2008;Mittlmeier & Beck 2005;Stedtfeld et al, 2004).…”

“…Ideally, the treatment of a supracondylar femoral fracture above a total knee arthroplasty would be characterised as follows (Kregor et al, 2001): -The ability of the patient to return to pre-accident function, -A surgical technique that is minimally invasive, -Capability of immediate motion, -No need for bone-grafting, -Low risk of infection, and -Adaptability to various total knee designs. In practice, flexible intramedullary nails, rigid retrograde IM nails, angled blade plates, cobra plates, dynamic condylar screws and Ilizarov external fixators have been used (Althausen et al, 2003;Beris et al, 2010;Chettiar et al, 2009;Gliatis et al, 2005;Maniar et al, 1996;McLaren et al, 1994;Rorabeck & Taylor, 1999;Zehntner & Ganz, 1993). Fixation with conventional compression plates, though for the most part successful, has its limitations (Kubiak et al, 2006).…”