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isplaced periprosthetic fractures of the distal part of the femur proximal to a stable total knee replacement are infrequent and present a challenging surgical problem 1 . The reported prevalence is 0.3% to 2.5%, but it is expected to increase because of the increased numbers of total knee replacements being performed and the increasing longevity of patients 2-5 .Treatment options include bed rest; traction and cast immobilization; operative fixation with Rush rods, supracondylar nails, and plates with or without bone-grafting; and revision arthroplasty with a long-stem prosthesis 1,2,4,6-10 . Each of these options is associated with substantial complications 2,5,7 .We have used external fixation systems to treat fractures in appropriately selected elderly patients 11 . External fixation offers secure fracture fixation and permits early mobilization of the patient.A hybrid external fixation frame stabilizes and realigns a fracture by combining (1) a distal circular fixation element to which tension wires, inserted through metaphyseal cancellous osteoporotic bone, are secured and (2) a proximal monolateral fixation element to which half-pins are secured for fixation to the diaphyseal bone. To the best of our knowl-D Fig. 1-A Initial anteroposterior (Fig. 1-A) and lateral ( Fig. 1-B) radiographs showing a Lewis and Rorabeck type-II periprosthetic supracondylar femoral fracture 3 in an eighty-three-year-old man with osteopenia and a stable implant. Fig. 1-B

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