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Online ISSN 1827-1707
ORTHOPEDIC TRAUMA UPDATE PART II
Trauma and Orthopaedics, Whipps Cross University Hospital Trust, London, UK
Although these types of periprosthetic fractures are uncommon they present with increasing frequency and are challenging to treat. The exponential rise in knee arthroplasty and the demographic trend to longevity mean that fractures around implants will become more prevalent. This article concentrates on the particular problems encountered when treating distal femoral fractures above a total knee replacement (TKR). According to recent estimates incidences of fracture after TKR are 0.3% to 2.5% (recent estimate [4.9%] and the prevalence at six years [1.8%]) and these type of fractures are more common in elderly and female patients. The most common fracture above a TKR is a supracondylar femoral fracture. Treatment can be conservative if the fracture is undisplaced and the implant is stable, otherwise operative intervention should be considered. The patient must be factored into the treatment plan to avoid problems related to osteoporosis, poor bone stock and reduce common problems such as non-union and malunion. Complication rates for both operative and non-operative treatment are 30%.