title: Similar outcomes of locking compression plating and retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis.
abstract: OBJECTIVE
  This meta-analysis was designed to compare clinical outcomes, including knee scale score and nonunion rate, of patients with periprosthetic supracondylar fractures of the distal femur after total knee arthroplasty (TKA) who were treated using locking compression plates and retrograde intramedullary nails.
  
  
  METHODS
  Studies were included in this meta-analysis if they compared clinical outcomes, including operation time, Knee Society Score (KSS), time to union, nonunion rate, and revision rate due to nonunion, in patients who underwent locking compression plate or retrograde intramedullary nail for periprosthetic distal femur fractures following TKA.
  
  
  RESULTS
  Eight studies were included in this meta-analysis. Mean operation time was 11 min shorter (95 % CI -9.56 to 31.33 min; n.s.) and KSS one point higher (95 % CI -8.88 to 11.10; n.s.) with retrograde intramedullary nail than with locking compression plate, but these differences were not statistically significant. The two groups were also similar in mean time to union (0.46 weeks 95 % CI -1.17 to 2.08 weeks; n.s.), the proportion of subjects with nonunion (OR 0.83, 95 % CI 0.26-2.60; n.s.) and the proportion that underwent revision surgery (OR 0.88, 95 % CI 0.32-2.40; n.s.).
  
  
  CONCLUSIONS
  Clinical outcomes, including nonunion and revision rates, were similar in patients who underwent locking compression plate and retrograde intramedullary nail fixation for periprosthetic supracondylar femoral fracture following TKA. Orthopaedic surgeons must train to master both the retrograde intramedullary nail and locking compression plate techniques because both approaches can be considered for periprosthetic distal femur fracture after TKA as they have similar clinicoradiologic outcomes.
  
  
  METHODS
  II.
authors.affiliation: Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea.
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Shin
authors.affiliation: Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea. eoak22@empal.com.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Lee
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001860:Bone Plates; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D061646:Operative Time; D057068:Periprosthetic Fractures / Q000209:etiology / Q000601:surgery*; D012086:Reoperation
keywords: Distal femur; Intramedullary nail; Locking plate; Periprosthetic fracture; Total knee arthroplasty