title: Management of distal femoral periprosthetic fractures by distal femoral locking plate: A retrospective study.
abstract: BACKGROUND
  Management of periprosthetic supracondylar femoral fractures is difficult. Osteoporosis, comminution and bone loss, compromise stability with delayed mobility and poor functional outcomes. Open reduction and internal fixation (ORIF) with anatomic distal femoral (DF) locking plate permits early mobilization. However, this usually necessitates bone grafting (BG). Biological fixation using minimally invasive techniques minimizes periosteal stripping and morbidity.
  
  
  METHODS
  31 patients with comminuted periprosthetic DF fractures were reviewed retrospectively from October 2006 to September 2012. All patients underwent fixation using a DF locking compression plate (Synthes). 17 patients underwent ORIF with primary BG, whereas 14 were treated by closed reduction (CR) and internal fixation using biological minimally invasive techniques. Clinical and radiological followup were recorded for an average 36 months.
  
  
  RESULTS
  Mean time to union for the entire group was 5.6 months (range 3-9 months). Patients of ORIF group took longer (Mean 6.4 months, range 4.5-9 months) than the CR group (mean 4.6 months, range 3-7 months). Three patients of ORIF and one in CR group had poor results. Mean knee society scores were higher for CR group at 6 months, but nearly identical at 12 months, with similar eventual range of motion.
  
  
  CONCLUSIONS
  Locked plating of comminuted periprosthetic DF fractures permits stable rigid fixation and early mobilization. Fixation using minimally invasive biological techniques minimizes morbidity and may obviate the need for primary BG.
authors.affiliation: Max Institute of Orthopedics and Joint Replacement, Max Super Specialty Hospital, Saket, New Delhi, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Thukral
authors.affiliation: Max Institute of Orthopedics and Joint Replacement, Max Super Specialty Hospital, Saket, New Delhi, India.
authors.forename: Sks
authors.initials: S
authors.lastname: Marya
authors.affiliation: Max Institute of Orthopedics and Joint Replacement, Max Super Specialty Hospital, Saket, New Delhi, India.
authors.forename: Chandeep
authors.initials: C
authors.lastname: Singh
keywords: Biological fixation; Femoral fractures; arthroplasty; bone plates; distal femur; knee; locking plate; periprosthetic fracture; total knee arthroplasty