PERIPROSTHETIC SUPRACONDYLAR FRACTURE OF THE FEMUR. IS IT THE END OF LIMB FUNCTION?

Abstract

Introduction: Management of supracondylar fractures above a TKR is a difficult problem, aggravated by the increasing number of arthroplasties carried out and the increase of the ageing population. The aim of this paper is to determine the limb function after treatment of these fractures.

Materials and Methods: We performed a retrospective study of the outcome of the treatment of suprandylar fractures above an ipsilateral TKR. All fractures were classified according to the Lewis & Rorabeck System. Conservative treatment was provided to eight fractures. Osteosynthesis using a Dynamic Condylar Screw (DCS) was performed to five patients. The largest group of twenty patients was treated with a retrograde supracondylar nail. Three patients underwent a revision surgery.

Results: Four out of eight fractures treated conservatively had a satisfactory outcome. All patients treated with a DCS achieved a satisfactory result. Seventy five percent of patients treated with a supracondylar nail gained adequate functional and anatomical result. Revision surgery was satisfactory in all cases.

Conclusion: The above-described fractures are still not very frequent, but represent a high risk of important complications, with potentially disastrous consequences. For those reasons and the poor bone stock in the elderly its management is controversial. The challenge for the surgeon is to achieve the goals of consolidation of the fracture, preservation of a painless TKR, and, restoration of the previous functional status. A complex group of factors, such as fracture pattern, implant status, bone quality and general condition of the patient, need to be assessed.