[Retrograde Intramedullary Nailing for Periprosthetic Fractures of the Distal Femur]

Overview

Journal Oper Orthop Traumatol

Publisher Springer

Specialties Emergency Medicine
Orthopedics

Date 2014 Sep 13

PMID 25213461

Citations 4

Authors

R Biber

H J Bail

Affiliations

Soon will be listed here.

Abstract

Objective: Intramedullary stabilization of periprosthetic distal femoral fractures by interlocking nailing. Closed reduction by retrograde nail can be combined with the use of transmedullary support screws (TMS principle of Stedtfeld).

Indications: Supracondylar fractures above stable knee arthroplasty (Rorabeck types I and II), femoral shaft fractures ipsilateral of stable hip and/or knee arthroplasty, contraindications for antegrade nailing

Contraindications: Closed box design of femoral implant, intercondylar distance of the femoral component smaller than nail diameter, more than 40° flexion deficit of the knee, inability to place two bicortical distal interlocking screws. Relative contraindication: insufficient overlap with proximal implants

Surgical Technique: Supine position and knee flexion of approximately 45°. Fluoroscopy should be possible between the knee and hip. Longitudinal skin incision into the pre-existing scar over the patellar tendon which is then split. The nail entry point is located in the intercondylar groove at the deepest point of Blumensaat's line, often predetermined by the femoral arthroplasty component. Reaming is rarely necessary. Transmedullary support screws may correct axial malalignment during nail insertion. Static interlocking in a direction from lateral to medial by the aiming device. Insertion of locking cap.

Postoperative Management: Retrograde nailing normally allows full weight bearing. Range of motion does not need to be restricted.

Results: Out of 101 fractures treated between 2000 and 2013 with a Targon RF nail (Aesculap, Tuttlingen, Germany) 10 were periprosthetic, all were classified as Rorabeck type II and of these 6 fractures were metaphyseal and 4 were diaphyseal. In four cases proximal implants were present. The mean operative time for periprosthetic fracture fixation did not significantly differ from that for normal retrograde femoral nailing. There were no postoperative infections, fixation failures or delayed unions. There was one revision for secondary correction of maltorsion.

Citing Articles

Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients.

Howard A, Myatt A, Hodgson H, Naeem H, Pepple S, Perumal A Eur J Orthop Surg Traumatol. 2023; 34(1):471-478.

PMID: 37612566 PMC: 10771351. DOI: 10.1007/s00590-023-03650-7.

[Clinical application of lower extremity axial distractor in closed reduction and retrograde intramedullary nail fixation of distal femoral fractures].

Zhou N, Ma M, Liu H, Zhao D, Wang Z Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021; 35(6):678-683.

PMID: 34142492 PMC: 8218174. DOI: 10.7507/1002-1892.202101066.

A new classification of TKA periprosthetic femur fractures considering the implant type.

Fakler J, Ponick C, Edel M, Mobius R, Brand A, Roth A BMC Musculoskelet Disord. 2017; 18(1):490.

PMID: 29178860 PMC: 5702181. DOI: 10.1186/s12891-017-1855-z.

Femoral Condyles Tangential Views: An Effective Method to Detect the Screw Penetration of Femoral Condyles After Retrograde Nailing.

Zheng Z, Yu X, Chen W, Liu Y, Yu K, Wu T Chin Med J (Engl). 2015; 128(24):3352-6.

PMID: 26668151 PMC: 4797512. DOI: 10.4103/0366-6999.171441.

References

Stedtfeld H, Mittlmeier T, Landgraf P, Ewert A . The logic and clinical applications of blocking screws. J Bone Joint Surg Am. 2005; 86-A Suppl 2:17-25. DOI: 10.2106/00004623-200412002-00004. View

Klemm K, Schellmann W . [Dynamic and static locking of the intramedullary nail]. Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed. 1972; 75(12):568-75. View

Figgie M, Goldberg V, Figgie 3rd H, Sobel M . The results of treatment of supracondylar fracture above total knee arthroplasty. J Arthroplasty. 1990; 5(3):267-76. DOI: 10.1016/s0883-5403(08)80082-4. View

Platzer P, Schuster R, Aldrian S, Prosquill S, Krumboeck A, Zehetgruber I . Management and outcome of periprosthetic fractures after total knee arthroplasty. J Trauma. 2010; 68(6):1464-70. DOI: 10.1097/TA.0b013e3181d53f81. View

Harris T, Ruth J, Szivek J, Haywood B . The effect of implant overlap on the mechanical properties of the femur. J Trauma. 2003; 54(5):930-5. DOI: 10.1097/01.TA.0000060999.54287.39. View

Rorabeck C, Taylor J . Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am. 1999; 30(2):209-14. DOI: 10.1016/s0030-5898(05)70075-4. View

Leung K, Shen W, So W, Mui L, Grosse A . Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the femur. J Bone Joint Surg Am. 1991; 73(3):332-40. View

Mittlmeier T, Beck M . [Retrograde medullary locking nail in periprosthetic distal femoral fracture after condylar knee joint replacement]. Unfallchirurg. 2005; 108(6):497-501. DOI: 10.1007/s00113-005-0956-6. View

Delport P, Van Audekercke R, Martens M, MULIER J . Conservative treatment of ipsilateral supracondylar femoral fracture after total knee arthroplasty. J Trauma. 1984; 24(9):846-9. DOI: 10.1097/00005373-198409000-00013. View

10.

Ebraheim N, Liu J, Hashmi S, Sochacki K, Moral M, Hirschfeld A . High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties. J Arthroplasty. 2011; 27(5):809-13. DOI: 10.1016/j.arth.2011.08.007. View

11.

Horne L, Blue B . Intraarticular heterotopic ossification in the knee following intramedullary nailing of the fractured femur using a retrograde method. J Orthop Trauma. 1999; 13(5):385-8. DOI: 10.1097/00005131-199906000-00013. View

12.

Szalay G, Meyer C, Mika J, Schnettler R, Thormann U . [Treatment of periprosthetic femoral fractures after total hip arthroplasty with specially constructed retrograde hollow nails]. Oper Orthop Traumatol. 2014; 26(6):611-24. DOI: 10.1007/s00064-013-0236-5. View

13.

Moed B, Watson J . [Not Available]. Oper Orthop Traumatol. 2006; 10(3):198-209. DOI: 10.1007/s00064-006-0057-x. View

14.

Tomas T, Nachtnebl L, Otiepka P . [Distal femoral periprosthetic fractures: classification and therapy]. Acta Chir Orthop Traumatol Cech. 2010; 77(3):194-202. View

15.

Biber R, Stedtfeld H . [Management of metaphyseal nonunions of the femur with retrograde nailing]. Unfallchirurg. 2007; 110(9):780-3. DOI: 10.1007/s00113-007-1277-8. View

16.

Herrera D, Kregor P, Cole P, Levy B, Jonsson A, Zlowodzki M . Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006). Acta Orthop. 2008; 79(1):22-7. DOI: 10.1080/17453670710014716. View

17.

Henry S, Trager S, Green S, Seligson D . Management of supracondylar fractures of the femur with the GSH intramedullary nail: preliminary report. Contemp Orthop. 1991; 22(6):631-40. View

18.

McGraw P, Kumar A . Periprosthetic fractures of the femur after total knee arthroplasty. J Orthop Traumatol. 2010; 11(3):135-41. PMC: 2948125. DOI: 10.1007/s10195-010-0099-6. View

19.

Kolb K, Koller H, Lorenz I, Holz U, Marx F, Grutzner P . Operative treatment of distal femoral fractures above total knee arthroplasty with the indirect reduction technique: a long-term follow-up study. Injury. 2009; 40(4):433-9. DOI: 10.1016/j.injury.2008.10.020. View

20.

Culp R, Schmidt R, Hanks G, Mak A, Esterhai Jr J, Heppenstall R . Supracondylar fracture of the femur following prosthetic knee arthroplasty. Clin Orthop Relat Res. 1987; (222):212-22. View