Abstract
Supracondylar femur fractures are an uncommon but serious complication following TKA. The optimal treatment method often depends on the specific fracture pattern and various patient-related factors, and can be controversial in many cases. Nonoperative treatment can be considered in low-demand patients with minimally displaced fractures, whereas fractures associated with loose components typically require revision surgery. Displaced fractures with well-fixed implants can be treated successfully using one of several different strategies. Internal fixation after open or closed reduction can be achieved using either an intramedullary device or plate-and-screw constructs. Good results have been reported using intramedullary nails, although their use is limited to certain fracture patterns and implants designs. Modern periarticular locking plates featuring polyaxial locking screws can be inserted laterally in a submuscular fashion and offer the ability to achieve rigid fixation in the short distal fragment. These plates offer a robust treatment option for most fracture patterns. Alternatively, reliable healing and good functional results can also be achieved by revision of the femoral component using stemmed implants to bypass the fracture site. This strategy typically does not require distal femoral replacement or conversion to a hinge, and can provide consistently good results. Regardless of the treatment method chosen, careful attention should be given at the time of surgery avoid malalignment, malrotation, and distraction at the fracture site which can compromise the ultimate clinical outcome. Intra-operative femoral fractures are a rare complication that usually occurs during exposure, bone preparation, or trialing. If recognised intra-operatively and treated appropriately, reliable healing can occur.
