Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006).
BACKGROUND
There is no consensus on the best treatment for periprosthetic supracondylar fracture.


METHODS
We systematically summarized and compared results of different fixation techniques in the management of acute distal femur fractures above a total knee arthroplasty (TKA). Several databases were searched (Medline, Cochrane library, OTA and AAOS abstract databases) and baseline and outcome parameters were abstracted.


RESULTS
We extracted data from 29 case series with a total of 415 fractures. The following outcomes were noted: a nonunion rate of 9%, a fixation failure rate of 4%, an infection rate of 3%, and a revision surgery rate of 13%. Retrograde nailing was associated with relative risk reduction (RRR) of 87% (p = 0.01) for developing a nonunion and 70% (p = 0.03) for requiring revision surgery compared to traditional (non-locking) plating methods. Point estimates also suggested risk reductions for locking plates, although these were not statistically significant (57% for nonunion, p = 0.2; 43% for revision surgery, p = 0.23) compared to traditional plating. RRRs for nonunion and revision surgery were also statistically significantly lower for retrograde nailing and locking plates compared to nonoperative treatment.


CONCLUSIONS
Modern-day treatment methods are superior to conventional treatment options in the management of distal femur fractures above TKAs. The results should be interpreted with caution, due to the lack of randomized controlled trials and the possible selection bias in case series.
Herrera
Diego A
DA
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Kregor
Philip J
PJ
Cole
Peter A
PA
Levy
Bruce A
BA
Jönsson
Anders
A
Zlowodzki
Michael
M
D000208:Acute Disease; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D001858:Bone Nails; D001860:Bone Plates; D016267:External Fixators; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D017063:Outcome Assessment, Health Care