Abstract
Following successful total knee arthroplasty, tibial periprosthetic fractures are rare and patellar fractures are sufficiently dependent upon vascular issues that they constitute a somewhat separate topic. Femoral periprosthetic fractures are extremely difficult to manage, usually producing flexion, internal rotation, and varus deformities. Malunion from insufficient stabilisation and stiffness from excessive immobilisation are the polar perils to be avoided. A variety of conservative treatment options will be discussed, ranging from casting and traction to open reduction and internal fixation. Within the latter category, recent enthusiasm has swayed the pendulum of therapeutic options towards intramedullary fixation. This can be accomplished using Rush rods, interprosthetic and intramedullary rods with fixation screws, and revisional knee arthroplasty techniques with large intramedullary stems. As a general rule, the more aggressive techniques provide the better results, although the severe technical difficulties of managing the osteopenic femoral medullary bone require special techniques and skills. Nonetheless, optimal results producing less than 5° of angulation and over 100° of motion are to be expected.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
