Repair of Distal Femoral Periprosthetic Nonunion: Linked Nail Plate Construct

Abstract

Introduction: Periprosthetic fracture nonunions represent a rare problem in orthopaedic practice, although their incidence has increased with the increased frequency of joint replacement surgery. This video demonstrates the use of a linked nail-plate construct to repair a distal femoral periprosthetic fracture nonunion. Methods: The patient is a 93-year-old woman who is 1-year status-post a left distal femoral periprosthetic fracture with known delayed healing. She presents with a low energy trauma and hardware failure. The patient was indicated for operative fixation using a linked nail-plate construct given the patient's previous hardware failure, advanced age, and poor bone quality. Results: This video demonstrates the linked nail-plate technique for the repair of a distal femoral periprosthetic fracture nonunion. Anatomical reduction and stable fixation with bone graft was performed with excellent results. There were no intraoperative or postoperative complications and no issues related to metallurgy. Conclusions: In this video, we present the case of an atrophic distal femoral periprosthetic nonunion treated with a linked nail-plate construct with autologous bone graft. Although femoral periprosthetic fracture nonunions are a rare occurrence, they can be successfully treated with operative intervention aimed at compression plating with supplemental bone grafting. Video available at: http://links.lww.com/JOT/A797

Double fixation for complex distal femoral fractures

“…Several case series have used the nail-and-plate construct in different clinical situations and reported overall high union rates (42,45,46,47,48). Liporace and Yoon (42) used the nail-and-plate construct for primary fracture fixation X-rays of the injury.…”

The linked nail/plate construct for the management of distal femur fractures in the elderly

“…In an attempt to overcome the above challenges and in order to provide the option of early weight bearing postoperatively, even for complex injuries, the nail plate (NP) has been introduced [10]. The NP construct includes the synergic use of a retrograde intramedullary nail (rIMN) and a distal lateral plate (LP), in order to maximize the stability of the construct leading to a sturdy fixation.…”

“…Despite several studies, focusing on the common complications of single implant constructs for the management of complex distal femur fractures, only a few studies focus on new hybrid techniques that can provide an adequate fixation method addressing the challenges that the complex distal femur fractures pose to the orthopedic surgeon [10,11].…”