J Korean Orthop Assoc.  2011 Oct;46(5):412-418.

Treatment of Periprosthetic Supracondylar Femur Fractures Following Total Knee Arthroplasty

• Kang HJ
• Chun CH
• Kim KM
• Han SS

Abstract

PURPOSE
This study examined the outcomes of treatment in periprosthetic supracondylar fractures of the femur after total knee arthroplasty with the plates of internal fixation and retrograde intramedullary nailing using clinical and radiological methods.
MATERIALS AND METHODS
Between August 1998 to May 2010, 24 cases of periprosthetic supracondylar fractures of the femur around the stem were selected and 18 cases of a stabled fracture without a loosening of the stem were chosen. The mean age was 69.1 (range 55-83) years and the mean follow period was 42.8 (range 14-142) months. In 18 cases, 8 cases who used a plate to gain anatomical alignment were categorized as group A and 10 cases who used retrograde intramedullary nailing were called group B. The union period, range of motion before fracture and last follow up, HSS score and tibiofemoral angle in both groups were compared.
RESULTS
Radiographic union was obtained in all cases. The mean union period was 5 and 4.8 month in group A and B, respectively. In group A, the range of motion just before fracture was 120degrees and the last follow up was 93degrees. In group B, the range of motion before fracture was 124.5degrees and the last follow up was 96.8degrees. Although the range of motion in both groups had decreased appreciably (p<0.001), there was no significant difference between them (p>0.05). The HSS score in group A was 87 just before the fracture and decreased to 79.8. The HSS score in group B was 85 before fracture and decreased to 81. The final HSS score at the last follow up decreased in both groups but the decrease and difference between the two groups was not significant (p>0.05). The coronal alignment in group A was 6.2 valgus just before the fracture and 4.4 valgus at the last follow up. The coronal alignment in group B was 6 valgus before the fracture and 5.2 valgus at the last follow up (p>0.05).
CONCLUSION
In the treatment of periprosthetic supracondylar fractures of the femur after total knee arthroplasty, both an open reduction with internal fixation of the plates and retrograde intramedullary nailing showed good results in the clinical and radiological fields.

Keyword

total knee arthroplasty; periprosthetic supracondylar fracture

MeSH Terms

Arthroplasty
Femur
Follow-Up Studies
Fracture Fixation, Intramedullary
Knee
Range of Motion, Articular

Figure

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  Figure 1 (A) Preoperative X-rays of a Rorabeck type II periprosthetic supracondylar fracture of the left knee in a 71-year-old woman. (B) Radiograph taken at 5 months after plate fixation showed rigid bony union and well maintained prosthesis.

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  Figure 2 (A) Preoperative X-rays of a Rorabeck type II periprosthetic supracondylar fracture of the left knee in a 79-year-old woman. (B) Radiographs taken at 4 months after retrograde intramedullary nailing show rigid bony union and well maintained prosthesis.

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