[Intramedullary nailing of periprosthetic femoral fractures after revision for total knee endoprosthesis. Treatment of periprosthetic femoral fractures by inserted knee endoprostheis with intramedullary shaft by in situ lengthening of the prosthesis with specially prepared slotted hollow nails]

Periprosthetic femoral fracture - an interdisciplinary challenge

BACKGROUND

The increasing implantation rates of total hip and knee prostheses have been accompanied by a corresponding rise in periprosthetic fractures (PPF), most often affecting the femur.

METHOD

This review is based on a selective search of the PubMed database for articles in English and German. The search was carried out with a set of pertinent medical subject headings (MeSH) and as a free text search employing a logical combination of search terms (evidence grade III-IV).

RESULTS

Soft-tissue-sparing, stable-angle plate osteosynthesis with a firmly seated implant is a safe treatment of periprosthetic femoral fracture (PPFF). A correct assessment of the stability of the prosthesis is a prerequisite for the success of treatment. A loose prosthesis must be surgically revised, and a failed osteosynthesis can also necessitate revision of the prosthesis. The conservative management of PPFF is generally not indicated, as it has a high complication rate.

CONCLUSION

The treatment of periprosthetic fractures requires competence, not just in osteosynthetic techniques, but also in endoprosthesis implantation and revision. Careful preoperative planning to select the proper treatment is essential, and the necessary equipment must be on hand.

Triple fracture during rehabilitation after revision total knee arthroplasty

PURPOSE

The incidence of periprosthetic fractures after knee-joint implant revisions is increasing in prevalence. We present a method of treatment for a patient who sustained a triple fracture--a periprosthetic femur fracture, a patella fracture, and a tibial shaft fracture.

METHODS

The femoral fracture was treated with a specially designed intramedullary nail, the patella fracture with a figure-of-eight suture, and the tibial shaft fracture by a minimal-invasive plate osteosynthesis using a percutaneous plating technique.

RESULTS

Osseous consolidation was confirmed, and the patient presented a satisfying range of movement under full-weight-bearing conditions after mobilisation.

CONCLUSIONS

Simultaneous multiple periprosthetic fractures are a special challenge, and in situ coupling of the endoprosthesis with a slotted hollow nail presents a valuable option for the treatment.

LEVEL OF EVIDENCE

Level V, Expert opinion.