title: The operative management of osteoporotic fractures of the knee: to fix or replace?
abstract: This review considers the surgical treatment   of displaced fractures involving the knee in elderly, osteoporotic patients.   The goals of treatment include pain control, early mobilisation,   avoidance of complications and minimising the need for further surgery.   Open reduction and internal fixation (ORIF) frequently results in   loss of reduction, which can result in post-traumatic arthritis   and the occasional conversion to total knee replacement (TKR). TKR   after failed internal fixation is challenging, with modest functional   outcomes and high complication rates. TKR undertaken as treatment   of the initial fracture has better results to late TKR, but does   not match the outcome of primary TKR without complications. Given   the relatively infrequent need for late TKR following failed fixation,   ORIF is the preferred management for most cases. Early TKR can be   considered for those patients with pre-existing arthritis, bicondylar   femoral fractures, those who would be unable to comply with weight-bearing restrictions,   or where a single definitive procedure is required.
authors.affiliation: Concordia Hip & Knee Institute, 301-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada. ebohm@cjrg.ca
authors.forename: E R
authors.initials: ER
authors.lastname: Bohm
authors.forename: T V
authors.initials: TV
authors.lastname: Tufescu
authors.forename: J P
authors.initials: JP
authors.lastname: Marsh
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D005264:Femoral Fractures / Q000145:classification / Q000150:complications / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007718:Knee Injuries / Q000145:classification / Q000150:complications / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology; D058866:Osteoporotic Fractures / Q000145:classification / Q000150:complications / Q000601:surgery*; D011182:Postoperative Care; D016059:Range of Motion, Articular; D013978:Tibial Fractures / Q000145:classification / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome