Session II - Femur

Thurs., 10/5/06 Femur, Paper #12, 4:12 pm

Locked Plating of Supracondylar Periprosthetic Femur Fractures

Thomas M. Large, MD1 (n); James Norton, PhD1 (n);
Michael J. Bosse, MD1 (n); Stephen H. Sims, MD1 (n);
John L. Masonis, MD2 (n); Peter L. Althausen, MD3 (n);
Domingo Hallare, MD3 (n); John P. Meehan, MD3 (n);
1Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA;
2OrthoCarolina, Charlotte, North Carolina, USA;
3Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California, USA

Purpose: We reviewed our results of lateral locked condylar plating versus other operative techniques to treat periprosthetic supracondylar femur fractures above a total knee arthroplasty (TKA).

Methods: A retrospective review of all operatively treated supracondylar femur fractures above a TKA treated between 1995 and 2005 identified 50 fractures in 50 patients. Fractures were limited to Lewis and Rorabeck Type II with a stable prosthesis. 29 patients (Group I), 14 with a posterior-stabilized femoral component, were treated with a LISS plate or with a lateral 4.5-mm Locked Condylar Plate. 21 patients comprised Group II - 10 treated with a variety of nonlocking plate systems, 4 with Rush Rods, and 7 with a retrograde intramedullary nail (IMN). We compared the operative data, the revision and complication rates, and the clinical and radiographic outcomes of these two treatment groups. 25 patients in group I were available for clinical and radiographic follow-up; average length of follow-up was 1.7 years. 19 patients in group II were available for follow-up; 15 were included for clinical and radiographic follow-up, with an average length of follow-up of 3.4 years.

Results: There were six malunions (24%) and no nonunions in Group I. There were nine malunions (47%) and three nonunions (16%) in Group II; both of these differences approached significance at P = 0.06. There were significantly (P = 0.03) more complications (8, or 42%) in Group II compared to three (12%) in Group I. Group II patients healed in a significantly (P <0.05) more shortened, flexed position. Group I patients had significantly greater knee flexion and total arc of motion. Group I patients had significantly less operative blood loss. All seven patients treated with a retrograde IMN had either a malunion, nonunion, or complication.

Conclusion/Significance: Locked plating is a reliable treatment option for supracondylar femur fractures above a TKA, including those with a posterior stabilized femoral component. We experienced a lower complication, revision, malunion, and nonunion rate with locked plating than with conventional treatment options.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.