Treatment of femoral fracture above a knee prosthesis. 18 cases followed 0.5-14 years.
We reviewed 16 patients who sustained 18 fractures above a total knee prosthesis. 5 fractures were undisplaced and were treated with either skeletal traction or a plaster cylinder. 3 did well, 1 patient suffered a cerebral vascular accident while still in plaster and 1 patient died of heart failure while on skeletal traction. 7 displaced fractures were treated initially with skeletal traction. 1 patient had a nonunion of the fracture and 2 a malunion and malfunction of the knee. 4 underwent various operations later because of malalignment and nonunion of the fracture with poor functional results. 6 displaced fractures were treated with immediate internal fixation. 5 recovered well and returned to pre-fracture activities. 1 patient's plate broke and further surgery was needed. We conclude that displaced fractures above a knee prosthesis should be treated with immediate stable internal fixation and early mobilization. Nonoperative treatment was satisfactory only for minor undisplaced fractures.
Orthopedic Department of Derbyshire Royal Infirmary, U.K.
C
C
Garnavos
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M
Rafiq
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AP
Henry
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods; D017759:Fractures, Malunited / Q000209:etiology; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014143:Traction; D016896:Treatment Outcome