Reduction and Locked Plate Fixation of Periprosthetic Femoral Fractures Above a Total Knee Arthroplasty

Abstract

Femoral fractures above knee joint replacements are becoming increasingly commonplace. Surgical treatment is preferred to facilitate mobilization and optimize functional outcome. Although medullary devices remain the gold standard for treatment of diaphyseal femoral fractures, the presence of a knee prosthesis makes this treatment method more difficult. Reduction and fixation strategies are affected by the fracture pattern/location, implant design, bone quality, and adjacent arthroplasty. Achieving a quality reduction is the critical first step to any successful fracture surgery. Both direct and indirect reduction methods can be used to realign displaced fractures before fixation. Although locked plating technology allows for durable stabilization by means of angular stability, it will neither substitute for poor fracture reduction nor devitalize the surgical technique. Variable angle-locking implants may be useful in capturing smaller segments of bone or cement, particularly in the distal metaphyseal segment. Hybrid fixation (a combination of locked and conventional screws) can provide a favorable biomechanical environment for healing. Successful outcomes depend upon a thorough understanding of the injury, a well-executed surgical tactic, and early mobilization of the extremity.