Special Technical ArticlesHybrid Stabilization of Periprosthetic Distal Femoral Fractures Following Total Knee Replacement: Technique and ResultsKalyanasundaram, Sivaprasad MS Orth, DNB Orth*; Pankapilly, Biju MD†; Varughese, Jacob MS Orth, MCh Orth*; Jacob, George MBBS‡; Menon, Venugopal K. MS Orth, MCh Orth, MSc Orth Engg*Author Information *Khoula Hospital, Muscat, Oman †Zulekha Hospital, Sharjah, UAE ‡KS Hegde Medical Academy, Mangalore, Karnataka, India The authors declare that they have nothing to disclose. For reprint requests, or additional information and guidance on the techniques described in the article, please contact Sivaprasad Kalyanasundaram, MS Orth, DNB Orth, at email@example.com or by mail at, Khoula Hospital, PO Box 90, Mina Al Fahal, Post Code 116, Muscat, Oman. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques. Techniques in Orthopaedics: June 2017 - Volume 32 - Issue 2 - p 126-130 doi: 10.1097/BTO.0000000000000192 Buy Metrics Abstract The incidence of periprosthetic distal femoral fractures after total knee replacement has been reported to be in the range of 0.3% to 2.5%. The treatment is technically challenging in fractures with small osteopenic distal fragment that might compromise stable fixation. Proper alignment and stabilization of the fracture is mandatory for early mobilization of the knee. Through the previous midline scar, knee is approached and with minimal soft tissue dissection a 7 or 9 mm supracondylar intramedullary nail is inserted retrograde achieving reduction and temporary stability. To augment the fixation, a distal femoral locking plate is slid submuscular by minimal invasive technique and held with screws. When possible, the nail locking screws are inserted through the plate, achieving stable reduction and adequate fixation to allow early mobilization during the postoperative period. Between 2009 and 2015, 13 patients with 14 type-2 periprosthetic supracondylar fractures were operated with the hybrid fixation technique. All the patients achieved union at 3 months with no loss of alignment or loss of range of motion. In type-2 supracondylar fractures with marked comminution, osteopenia, and small distal fragment, the hybrid fixation technique achieves satisfactory reduction and adequate stabilization that helps in early mobilization and fracture healing without additional periosteal damage to the distal fragment. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.