Comparison of retrograde nailing and minimally invasive plating for treatment of periprosthetic supracondylar femur fractures (OTA 33-A) above total knee arthroplasty
- 995 Downloads
Retrograde intramedullary (IM) nailing and minimally invasive plate osteosynthesis (MIPO) using locking plate are typically considered the gold standards of treatment for periprosthetic supracondylar femoral fractures above total knee arthroplasty (TKA).
Forty-one consecutive patients treated with either retrograde nailing (nail group, n = 20) or minimally invasive plating (plate group, n = 21) for periprosthetic supracondylar femoral fractures between March 2003 and January 2014 were retrospectively reviewed. Clinical functions [arc range of motion and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score] and bony outcomes (bony union and malunion) were evaluated.
There was no statistical difference between the nail and plate groups in age (p = 0.665), one-year postoperative arc range of motion (p = 0.642), preoperative WOMAC score (p = 0.076), postoperative one-year WOMAC score (p = 0.135), and union time (p = 0.081). The mean union time of the nail group and the plate group was 4.3 months (range 3–12 months) and 3.6 months (range 3–5 months), respectively. There were three cases of malalignment in the nail group, whereas there was one case of malalignment in the plate group (p = 0.343). One case of nailing using a short nail demonstrated nail breakage.
Although retrograde nailing was found to have a slightly higher rate of malunion compared to minimally invasive plating, there was no statistically significant difference between both treatment options in terms of clinical outcomes. Regardless of which implant is used, the proper application is essential in management of periprosthetic supracondylar femoral fractures above TKA.
KeywordsSupracondylar femur Periprosthetic fracture Total knee arthroplasty Nailing Plating
Compliance with ethical standards
Conflicts of interest and source of funding
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
- 11.Kregor PJ, Hughes JL, Cole PA (2001) Fixation of distal femoral fractures above total knee arthroplasty utilizing the Less Invasive Stabilization System (L.I.S.S.). Injury 32 Suppl 3:SC64–75Google Scholar
- 14.Bong MR, Egol KA, Koval KJ, Kummer FJ, Su ET, Iesaka K, Bayer J, Di Cesare PE (2002) Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty. J Arthroplasty 17(7):876–881CrossRefPubMedGoogle Scholar
- 22.Krettek C, Miclau T, Schandelmaier P, Stephan C, Mohlmann U, Tscherne H (1999) The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma 13(8):550–553CrossRefPubMedGoogle Scholar