O3028 SUPRACONDYLAR NAILING OF FRACTURES OF THE DISTAL FEMUR AFTER TOTAL KNEE ARTHROPLASTY

Abstract

Aim: To report the results of supracondylar nailing of periprosthetic fractures of the distal femur above total knee replacement. Methods: Six displaced peri-prosthetic fractures of the distal femur in six female patients were treated with titanium supracondylar nail (Depuy ACE) between October 1997 and November 1999. The mean age was 68 years (42–92). Four patients had history of rheumatoid arthritis and two had previously undergone bilateral total hip replacement. None of the patients was reported to have anterior notching of the distal femur. Six fractures were equally distributed between right and left side. Low velocity trauma was the cause of fracture in all patients. The knee implants were in place for an average period of 36 months (3 wk to 48 months). The average follow up was 20 months (6–36). Results: All fractures healed in an average period of 14.6 weeks (12–18). One patient suffered another fall and sustained a fracture of the shaft of the femur above the nail. This was treated with exchange nailing using a long supracondylar nail with good result. All fractures healed in a satisfactory alignment. There were no cases of infection, loss of reduction and implant failure. All patients achieved their pre-injury functional status. The average ROM at the knee was 86.6 degrees (70–100). At latest follow up, none of the prostheses showed any signs of loosening and two patients had undergone total knee replacement on the contralateral side. Conclusion: Supracondylar nailing is a satisfactory method of managing periprosthetic fractures of the distal femur above a well-þxed implant.