Outcomes of Surgical Management of Supracondylar Periprosthetic Femur Fractures

• Published in: The Journal of arthroplasty 2017-01, Vol.32 (1), p.189-192
• Main Authors: Matlovich, N., MD, Lanting, B., MD, MSc, FRCSC, Vasarhelyi, E.M., MD, MSc, FRCSC, Naudie, D.D., MD, FRCSC, McCalden, R.W., MD, FRCSC, Howard, J.L., MD, MSc, FRCSC
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee - adverse effects; Bone Nails; Bone Plates - adverse effects; Female; Femoral Fractures - surgery; Femoral Neck Fractures - surgery; fracture; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Intramedullary - instrumentation; Gait; Health Services; Humans; intramedullary nail; locking plate; Male; Middle Aged; Orthopedics; Pain, Postoperative; periprosthetic; Periprosthetic Fractures - surgery; Postoperative Complications - surgery; Postoperative Period; Radiography; Range of Motion, Articular; Retrospective Studies; supracondylar; TKA flange; Treatment Outcome; Weight-Bearing
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.06.056

Abstract Background Fracture location is an important consideration in managing supracondylar periprosthetic femur fractures. The outcomes of locked plating and intramedullary (IM) nail fixation were therefore compared based on fracture location, being above or at/below the total knee arthroplasty (TKA) flange. Methods Fifty seven patients were identified from surgical records as being treated for supracondylar periprosthetic femur fracture with either a locking plate (n=38) or IM Nail (n=19). Based on fracture location, either above or at/below the TKA flange, both groups were assessed for time to full weight bearing, time to radiographic union, number of post operative complications, subsequent surgery, transfusion requirements, as well as range of motion (ROM), pain, and instability at most recent follow-up. Radiographs were reviewed to assess fracture alignment with comparisons made immediately post-op to most recent. Results Mean follow-up for IM nail and locking plate fixation was 13.9 and 15.6 months respectively. There was no statistical difference between groups in the mean time to fully weight bear, the incidence of post operative pain, range of motion, use of gait aids, time to full radiographic union or the overall radiographic alignment of a healed fracture (P>0.05). Comparison based on fracture location yielded similar outcomes. Non-union was only demonstrated in the IM nail cohort, particularly for fractures below the TKA flange (n=2). Conclusions The use of either IM Nail or locking plate fixation for supracondylar periprosthetic fractures provides comparable clinical outcomes. Caution is recommended in using IM nails for fractures below the flange where limited fixation may increase the risk of nonunion.