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KMID : 0361620110460050412
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Journal of the Korean Orthopaedic Association
2011 Volume.46 No. 5 p.412 ~ p.418
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Treatment of Periprosthetic Supracondylar Femur Fractures Following Total Knee Arthroplasty
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Kang Hong-Je
Chun Churl-Hong
Kim Kwang-Mee
Han Sang-Su
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Abstract
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Purpose:This study examined the outcomes of treatment in periprosthetic supracondylar fractures of the femur after total knee arthroplasty with the plates of internal fixation and retrograde intramedullary nailing using clinical and radiological methods.
Materials and Methods : Between August 1998 to May 2010, 24 cases of periprosthetic supracondylar fractures of the femur around the stem were selected and 18 cases of a stabled fracture without a loosening of the stem were chosen. The mean age was 69.1 (range 55-83) years and the mean follow period was 42.8 (range 14-142) months. In 18 cases, 8 cases who used a plate to gain anatomical alignment were categorized as group A and 10 cases who used retrograde intramedullary nailing were called group B. The union period, range of motion before fracture and last follow up, HSS score and tibiofemoral angle in both groups were compared.
Results:Radiographic union was obtained in all cases. The mean union period was 5 and 4.8 month in group A and B, respectively. In group A, the range of motion just before fracture was 120° and the last follow up was 93° In group B, the range of motion before fracture was 124.5° and the last follow up was 96.8°. Although the range of motion in both groups had decreased appreciably (p<0.001), there was no significant difference between them (p>0.05). The HSS score in group A was 87 just before the fracture and decreased to 79.8. The HSS score in group B was 85 before fracture and decreased to 81. The final HSS score at the last follow up decreased in both groups but the decrease and difference between the two groups was not significant (p>0.05). The coronal alignment in group A was 6.2 valgus just before the fracture and 4.4 valgus at the last follow up. The coronal alignment in group B was 6 valgus before the fracture and 5.2 va lgus at the last follow up (p>0.05).
Conclusion:In the treatment of periprosthetic supracondylar fractures of the femur after total knee arthroplasty, both an open reduction with internal fixation of the plates and retrograde intramedullary nailing showed good results in the clinical and radiological fields.
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KEYWORD
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total knee arthroplasty, periprosthetic supracondylar fracture
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