title: Comparison of retrograde nailing and minimally invasive plating for treatment of periprosthetic supracondylar femur fractures (OTA 33-A) above total knee arthroplasty.
abstract: BACKGROUND
  Retrograde intramedullary (IM) nailing and minimally invasive plate osteosynthesis (MIPO) using locking plate are typically considered the gold standards of treatment for periprosthetic supracondylar femoral fractures above total knee arthroplasty (TKA).
  
  
  METHODS
  Forty-one consecutive patients treated with either retrograde nailing (nail group, n = 20) or minimally invasive plating (plate group, n = 21) for periprosthetic supracondylar femoral fractures between March 2003 and January 2014 were retrospectively reviewed. Clinical functions [arc range of motion and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score] and bony outcomes (bony union and malunion) were evaluated.
  
  
  RESULTS
  There was no statistical difference between the nail and plate groups in age (p = 0.665), one-year postoperative arc range of motion (p = 0.642), preoperative WOMAC score (p = 0.076), postoperative one-year WOMAC score (p = 0.135), and union time (p = 0.081). The mean union time of the nail group and the plate group was 4.3 months (range 3-12 months) and 3.6 months (range 3-5 months), respectively. There were three cases of malalignment in the nail group, whereas there was one case of malalignment in the plate group (p = 0.343). One case of nailing using a short nail demonstrated nail breakage.
  
  
  CONCLUSIONS
  Although retrograde nailing was found to have a slightly higher rate of malunion compared to minimally invasive plating, there was no statistically significant difference between both treatment options in terms of clinical outcomes. Regardless of which implant is used, the proper application is essential in management of periprosthetic supracondylar femoral fractures above TKA.
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, 25, Simgok-ro 100 beon-gil, Seo-gu, Incheon, 404-834, Republic of Korea. parkjinos@gmail.com.|Department of Orthopedic Surgery, Medical School and Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Republic of Korea. parkjinos@gmail.com.
authors.forename: Jin
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Medical School and Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Republic of Korea. jhlee55@jbnu.ac.kr.
authors.forename: Ju Hong
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D057068:Periprosthetic Fractures / Q000601:surgery*; D011184:Postoperative Period; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Nailing; Periprosthetic fracture; Plating; Supracondylar femur; Total knee arthroplasty