title: Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006).
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Herrera
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kregor
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cole
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Levy
authors.forename: Anders
authors.initials: A
authors.lastname: Jönsson
authors.forename: Michael
authors.initials: M
authors.lastname: Zlowodzki
mesh_terms: 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