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Similar results seen for periprosthetic femur fractures treated with IM nail vs locked plate fixation
Similar clinical outcomes were seen for patients with supracondylar periprosthetic femur fractures treated with either locking plate or intramedullary nail fixation, according to recently published results.
Researchers used surgical records to identify 57 patients who underwent surgical treatment for supracondylar periprosthetic femur fractures. Thirty-eight patients underwent treatment with locking plate fixation and 19 patients were treated with intramedullary (IM) nail fixation. The mean follow-up was 13.9 months for patients treated with an IM nail and 15.6 months for patients treated with a locking plate. Investigators evaluated patients for time to full weight-bearing, time to radiographic union, number of postoperative complications, the need for subsequent surgery and transfusion, range of motion, pain and instability based on the location of the fracture.
Results showed the mean postoperative pain, range of motion, use of aids for gait, time to full radiographic union, alignment of coronal and sagittal planes for the healed fracture, and time to full weight-bearing were not significantly different between patients treated with a locking plate and patients treated with an IM nail. Investigators noted the reoperation rate was greater in patients treated with an IM nail compared with patients treated with the locked plate (26.3% vs. 2.7%). Nonunion was only seen in patients treated with an IM nail.
“Caution is recommended in using IM nails for fractures below the flange where limited fixation may increase the risk of nonunion,” the researchers wrote. ‒ by Monica Jaramillo
Disclosures: Matlovich reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to TopThis retrospective review of 55 patients with periprosthetic distal femur fractures stratified outcomes based on location of the fracture, above the TKA flange vs. at or distal to the flange, and by treatment method, open reduction and internal fixation (ORIF) with locked plate vs. IM nail. When comparing ORIF with IM nail treatment, there were no differences in range of motion (regardless of fracture location), chronic postoperative pain, time to union (regardless of fracture location), infection or alignment.
Patients treated with IM nails had more subjective instability, a higher reoperation rate (two for nonunion and three for hardware removal) and a lower transfusion rate. The study is limited by the small number of patients in subgroups (as little as seven treated with an IM nail for a distal fracture).
Both locked plating and IM nailing remain viable options for the treatment of distal femur periprosthetic fractures. Attention to technical detail is critical to avoid complications.