Hybrid Stabilization of Periprosthetic Distal Femoral Fractures Following Total Knee Replacement: Technique and Results

Abstract

The incidence of periprosthetic distal femoral fractures after total knee replacement has been reported to be in the range of 0.3% to 2.5%. The treatment is technically challenging in fractures with small osteopenic distal fragment that might compromise stable fixation. Proper alignment and stabilization of the fracture is mandatory for early mobilization of the knee. Through the previous midline scar, knee is approached and with minimal soft tissue dissection a 7 or 9 mm supracondylar intramedullary nail is inserted retrograde achieving reduction and temporary stability. To augment the fixation, a distal femoral locking plate is slid submuscular by minimal invasive technique and held with screws. When possible, the nail locking screws are inserted through the plate, achieving stable reduction and adequate fixation to allow early mobilization during the postoperative period. Between 2009 and 2015, 13 patients with 14 type-2 periprosthetic supracondylar fractures were operated with the hybrid fixation technique. All the patients achieved union at 3 months with no loss of alignment or loss of range of motion. In type-2 supracondylar fractures with marked comminution, osteopenia, and small distal fragment, the hybrid fixation technique achieves satisfactory reduction and adequate stabilization that helps in early mobilization and fracture healing without additional periosteal damage to the distal fragment.

Fixation techniques for periprosthetic femur fractures around total knee arthroplasty: a systematic review

“…Abstracts of the remaining 226 studies were reviewed and 116 were excluded. A total of 110 articles were selected for full-text review and 79 studies were excluded, leaving a final total of 31 of included studies 4,6,9,15–42 …”

“…However, only one study met all the inclusion criteria. 30 Kalyanasundaram et al reported on a series with 14 patients using the NPC technique. All 14 fractures healed uneventfully, with the mean union time of 3 mo.…”

“…We identified 5 studies using the NPC technique in our initial search. However, only one study met all the inclusion criteria 30 . Kalyanasundaram et al reported on a series with 14 patients using the NPC technique.…”

Management of a Complex Supracondylar Periprosthetic Femur Fracture with Intramedullary Strut Allograft and Bilateral Locking Plates

“…The deficient bone density in the distal femoral region as well as the low fracture localization adjacent to an arthroplasty component [ 2 ] obligates the modification of traditional fixation techniques. Specifically, low fractures with a little distal osteopenic fragment would impede strong fixation [ 10 ].…”