Osteosynthesis for periprosthetic supracondylar fracture above a total knee arthroplasty using a locking compression plate

摘要: Purpose of the study The frequency periprosthetic fractures related to total knee arthroplasty is increasing, with a prevalence 1.3% on average and women being affected more often (4 out 5 patients). Fractures distal femur are common, while tibial rare. Crucial for treatment distinguish metaphysis above femoral component, which remains firmly fixed, from those involving joint replacement component loosening. Supracondylar almost always managed surgically, using methods osteosynthesis an angle condylar or DCS plate, short retrograde- inserted supracondylar intramedullary nail. recent use implants such as LCPs angle-stable screws has offered good prospects. This retrospective presents our first experience LCP joint. Material Between 2005 2008, 13 were treated by technique. patient group included 10 three men age was 67.4 (range, 56-81) years. classified system proposed Su et al. AO classification system. According classification, 12 types I II one type III fracture indicated osteosynthesis. Based there four 33 A1 fractures, five A2 A3 C2 initially incorrectly fracture. time between injury 6.8 In all patients occurred after primary implantation cemented without stem.The less invasive technique within 2.5 days injury. followed up until radiographic union, complications recorded. Results through approach. One had spongioplasty, two spongioplasty interval 7 weeks. died disease unrelated trauma surgery at 3 months patient, failed fragment dislocation shortly operation. case analysis showed that initial indication marginal comminuted zone too low implant, line extending component. Subsequently, conversion revision stem carried out. nine patients, bone union achieved in 18 weeks, evidence union. No wound infection, delayed healing thromboembolic failure pseudoarthrosis development occurred. Discussion There only few reports evaluation its results literature, groups evaluated small. meta-analysis cases 1981 2006 period, Herrera have found 29 assessable studies 415 cases, i.e., 14 per study. usual method plate Complications associated conventional techniques, reported various authors, may reach 30% (pseudoarthrosis development, 9% failure, 4% necessity surgery, 13% malunion, 47%).Good been retrograde-inserted literature occasionally. described Rorabeck most widely used, but seems convenient us, because placed groups, according localisation distance follows: 1 fracture, proximal 2 starts level edge runs proximally extends below upper end Type retro- grade-inserted nail, osteosynthesis, arthroplasty. arthroplasty, success rate 86%, Ricci Other authors also report better outcomes LISS than techniques. Conclusions Osteosynthesis table efficient suitable It offers advantages implants. effective osteoporotic implant it provides fixation stability fragment. However, further needed compare efficiency IM