Hybrid External Fixation as a New Treatment Method for Periprosthetic Femoral Fracture: A Case Report

Abstract

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

Are extreme distal periprosthetic supracondylar fractures of the femur too distal to fix using a lateral locked plate?

“…2 Several surgical options have evolved, including hybrid external fixation, intramedullary nailing, and conventional and locked plate fixation. [22][23][24][25][26][27] The complication rate for conventional, non-locked plating is high. Using conventional plating, Figgie et al 5 had a 50% nonunion rate in ten supracondylar periprosthetic femoral fractures.…”

Expandable Retrograde Nail for Femoral Fracture above a Total Knee Replacement

“…Currently there is focus on three different methods in treatment of type 2 periprosthetic femoral fractures [1,[4][5][6]9,10,12,14,15]. These are osteosynthesis with a circular external fixation, blades and RIMN's.…”

“…Patient and technique related predisposing factors are osteopenia, osteolysis, malalignment, anterior femoral notching, poor flexion (stiff knee), corticosteroid use, rheumatoid arthritis, myasthenia gravis and cerebral palsy [1,3]. The reported periprosthetic fracture incidence ranges from 0.3 to 2.5 percent [1,4]. But unfortunately an increase of periprosthetic fracture incidence would be inevitable due to increased life expectancy and osteoporotic patient numbers [3,[5][6][7].…”

“…The most prevalent type of periprosthetic fracture is the Rorabeck type 2 [1,[9][10][11][12]. Recommended treatment options are plating, external fixation and retrograde intramedullary nailing (RIMN) [1,4,13,14]. There is still continuing debate which treatment option is optimal for these patients [1,4,7,13].…”

“…Recommended treatment options are plating, external fixation and retrograde intramedullary nailing (RIMN) [1,4,13,14]. There is still continuing debate which treatment option is optimal for these patients [1,4,7,13]. There is no consensus on the technique to be used but logically it must be minimally invasive to decrease mortality and morbidity [6,7,14] .…”