McMaster University

McMaster University

Systematic Review of the Treatment of Periprosthetic Distal Femur Fractures

MacOrtho is pleased to announce the most recent publication in the Journal of Orthopaedic Trauma. This publication is entitled, “Systematic Review of the Treatment of Periprosthetic Distal Femur Fractures."

To read more, click here to access the full-version of the article.

Ristevski B, Nauth A, Williams D, Hall J, Whelan D, Bhandari M, Schemitsch E. Systematic Review of the Treatment of Periprosthetic Distal Femur Fractures. J Orthop Trauma. 2013 Oct 21. [Epub ahead of print]


OBJECTIVES: To systematically review and compare non-operative and operative treatments for the management of periprosthetic distal femur fractures adjacent to total knee arthroplasties. Specific operative interventions compared included locked plating, retrograde intramedullary nailing (RIMN), and conventional (non-locked) plating. Where possible, data was pooled to arrive at summary estimates of treatment effect (Odds Ratios with associated 95% confidence intervals).

METHODS: A comprehensive database search (via Pubmed, Medline, Cochrane Database, and the OTA Database) was completed, yielding 44 eligible studies with a total of 719 fractures for analysis. Pertinent outcomes including malunion, nonunion and the need for secondary surgical procedures (SSPs) were compared statistically.

RESULTS: Both locked plating and RIMN demonstrated significant advantages over non-operative treatment. Some advantages were also observed when locked plating and RIMN were compared to conventional (non-locked) plates. Comparison of locked plating and RIMN showed no significant differences with regard to nonunion rates (OR=0.39, 95% CI= 0.13, 1.15, p=0.09) or rate of SSPs (OR=0.65, 95% CI=0.31, 1.35, p=0.25). However, RIMN demonstrated a significantly higher malunion rate when compared to locked plating (OR=2.37,95% CI=1.17-4.81, p=0.02).

CONCLUSION: Locked plating and RIMN offer significant advantages over non-operative treatment and conventional (non-locked) plating techniques in the management of periprosthetic femur fractures above total knee arthroplasties. Locked plating demonstrated a trend towards increased nonunion rates when compared to RIMN. Malunion was significantly higher with RIMN compared to locked plating.

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