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Use of an intramedullary fibular strut allograft and dual locking plate in periprosthetic fractures above total knee arthroplasty: new application of a well-known treatment method in trauma

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Augmenting fracture fixation with intramedullary fibular graft has seen several applications such as in comminuted proximal humerus fractures, and femoral neck and shaft nonunion. The purpose of this study was to report the first case series demonstrating the novel application of an intramedullary fibular allograft strut and dual locking plates on complicated periprosthetic fracture of distal femur.

Methods

The patient demographics, weight-bearing status, and radiographic and clinical outcomes of six patients, who were treated for periprosthetic distal femur fractures using an intramedullary fibular allograft strut and dual locking plate, between January 2018 and April 2020 were analyzed.

Results

Postoperative range of knee motion showed median 10’ (range 10–20) of flexion contracture and 90’ (range 80–110) of further flexion. Postoperative joint function was assessed according to the Kolmert functional criteria, with “excellent to good” in angular deformity and “Good to fair” result in range of motion and pain. RUSH score was assessed, and median score was 24 (range 18–26). All patients were able to ambulate without assistance 6 months after surgery.

Conclusion

In summary, the application of fibular strut graft and dual locking plate might be an option in complicated distal femur fracture above total knee arthroplasty. Albeit with an available number, such application showed promise as an intramedullary and cortical support for both reduction and maintenance of correction alignment, length, and prevention of further angular deformity.

Level of evidence IV: Surgical technique and Cases-series.

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Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, College of Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon, Republic of Korea

    Dongwhan Suh, Jong-Hun Ji & Heeman Chi

  2. Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jong-Hun Ji & Se-Won Lee

  3. Department of Orthopedic Surgery, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, 10, 63-Ro, Yeongdeungpo-Gu, Seoul, 07345, Republic of Korea

    Jun-Young Heu & Se-Won Lee

  4. Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea

    Jung-Youn Kim

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  1. Dongwhan Suh
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Contributions

DS and S-W L made contribution to study design, acquisition, interpretation of data and writing of the manuscript. J-H J, HC, J-Y H, and J-Y K were involved in data collection and analysis. S-W L supervised investigation and its interpretation. All authors made critical feedback and helped shape the study, analysis, and manuscript.

Corresponding author

Correspondence to Se-Won Lee.

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All authors have no conflict of interest.

Ethics approval

This study was approved by IRB: DC21RISI0060.

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Suh, D., Ji, JH., Heu, JY. et al. Use of an intramedullary fibular strut allograft and dual locking plate in periprosthetic fractures above total knee arthroplasty: new application of a well-known treatment method in trauma. Eur J Trauma Emerg Surg 48, 4105–4111 (2022). https://doi.org/10.1007/s00068-022-01940-z

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  • DOI: https://doi.org/10.1007/s00068-022-01940-z

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