title: Periprosthetic supracondylar femoral fractures following total knee arthroplasty: clinical comparison and related complications of the femur plate system and retrograde-inserted supracondylar nail.
abstract: BACKGROUND
  The purpose of this study is to analyze the clinical results and related complications of the femur plate system (FP) and the retrograde-inserted supracondylar nail (RISN).
  
  
  METHODS
  The study included 42 cases of periprosthetic supracondylar femoral fractures (PSF) proximal to posterior stabilized total knee arthroplasty between 2005 and 2009. Twenty-four cases of PSF were treated with the FP, and the other 18 cases were treated with the RISN. This study cohort was divided into subgroups according to the AO classification. We retrospectively compared the clinical results between the FP and RISN group.
  
  
  RESULTS
  There were no significant differences between the two groups in terms of time of clinical union (p = 0.649). In the subgroup analysis, the mean operation time was significantly different only in subgroup A1 (p = 0.03). Complications were seen in 29.2 % (7/24) of patients in the FP group and 27.8 % (5/18) in the RISN group. The age during the index TKA and fracture fixation was a significant risk (p = 0.008) factor for complications between the two groups. No significant differences were found in the other factors between the two groups. The p value for operative time (p = 0.223), immobilization period (p = 0.129), ROM (p = 0.573), KSS (p = 0.379), KSS functional scores (p = 0.310) and time to union (p = 0.649).
  
  
  CONCLUSIONS
  Clinical results did not differ according to the treatment methods used. Fixation method and fracture type did not cause an increase in the complication rate, but there was a trend toward higher non-union rates with the FP method and higher re-fracture rate with the RISN method. Noting the fact that only increasing age correlated with an increased complication rate, more careful attention should be paid to elderly patients in terms of both prevention and surgical care.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 20-8, Songpa-dong, Songpa-gu, Seoul, 138-170, Korea.
authors.forename: Viral
authors.initials: V
authors.lastname: Gondalia
authors.forename: Duck Hyun
authors.initials: DH
authors.lastname: Choi
authors.forename: Su Chan
authors.initials: SC
authors.lastname: Lee
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Nam
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Hwang
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Ahn
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Ong
authors.forename: Ha Young
authors.initials: HY
authors.lastname: Park
authors.forename: Kwang Am
authors.initials: KA
authors.lastname: Jung
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001858:Bone Nails / Q000009:adverse effects*; D001860:Bone Plates / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome