title: Outcomes of Surgical Management of Supracondylar Periprosthetic Femur Fractures.
abstract: Fracture location is an important consideration in managing supracondylar periprosthetic femur fractures. The outcomes of locked plating and intramedullary (IM) nail fixation were therefore compared based on fracture location, being above or at/below the total knee arthroplasty (TKA) flange.
  
  
  
  Fifty-seven patients were identified from surgical records as being treated for supracondylar periprosthetic femur fracture with either a locking plate (n = 38) or IM nail (n = 19). Based on fracture location, either above or at/below the TKA flange, both groups were assessed for time to full weight bearing, time to radiographic union, number of postoperative complications, subsequent surgery, transfusion requirements, as well as range of motion, pain, and instability at most recent follow-up. Radiographs were reviewed to assess fracture alignment with comparisons made immediately postoperative to most recent.
  
  
  
  Mean follow-up for IM nail and locking plate fixation was 13.9 and 15.6 months, respectively. There was no statistical difference between groups in the mean time to fully weight bear, the incidence of postoperative pain, range of motion, use of gait aids, time to full radiographic union, or the overall radiographic alignment of a healed fracture (P > .05). Comparison based on fracture location yielded similar outcomes. Nonunion was only demonstrated in the IM nail cohort, particularly for fractures below the TKA flange (n = 2).
  
  
  
  The use of either IM nail or locking plate fixation for supracondylar periprosthetic fractures provides comparable clinical outcomes. Caution is recommended in using IM nails for fractures below the flange where limited fixation may increase the risk of nonunion.
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Matlovich
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Lanting
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Vasarhelyi
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Naudie
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
authors.forename: Richard W
authors.initials: RW
authors.lastname: McCalden
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Howard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001858:Bone Nails; D001860:Bone Plates / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005265:Femoral Neck Fractures / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D005684:Gait; D006296:Health Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D057068:Periprosthetic Fractures / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011184:Postoperative Period; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: TKA flange; fracture; intramedullary nail; locking plate; periprosthetic; supracondylar