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European Journal of Trauma and Emergency Surgery

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06-03-2022 | Periprosthetic Fracture | Original Article

Use of an intramedullary fibular strut allograft and dual locking plate in periprosthetic fractures above total knee arthroplasty: new application of a well-known treatment method in trauma

Authors: Dongwhan Suh, Jong-Hun Ji, Jun-Young Heu, Jung-Youn Kim, Heeman Chi, Se-Won Lee

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

Abstract

Purpose

Augmenting fracture fixation with intramedullary fibular graft has seen several applications such as in comminuted proximal humerus fractures, and femoral neck and shaft nonunion. The purpose of this study was to report the first case series demonstrating the novel application of an intramedullary fibular allograft strut and dual locking plates on complicated periprosthetic fracture of distal femur.

Methods

The patient demographics, weight-bearing status, and radiographic and clinical outcomes of six patients, who were treated for periprosthetic distal femur fractures using an intramedullary fibular allograft strut and dual locking plate, between January 2018 and April 2020 were analyzed.

Results

Postoperative range of knee motion showed median 10’ (range 10–20) of flexion contracture and 90’ (range 80–110) of further flexion. Postoperative joint function was assessed according to the Kolmert functional criteria, with “excellent to good” in angular deformity and “Good to fair” result in range of motion and pain. RUSH score was assessed, and median score was 24 (range 18–26). All patients were able to ambulate without assistance 6 months after surgery.

Conclusion

In summary, the application of fibular strut graft and dual locking plate might be an option in complicated distal femur fracture above total knee arthroplasty. Albeit with an available number, such application showed promise as an intramedullary and cortical support for both reduction and maintenance of correction alignment, length, and prevention of further angular deformity.

Level of evidence IV: Surgical technique and Cases-series.

Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am. 2014;96:624–30. https://doi.org/10.2106/JBJS.M.00285.CrossRefPubMed

DiGioia A 3rd, Rubash HE. Periprosthetic fractures of the femur after total knee arthroplasty. A literature review and treatment algorithm. Clin Orthop Relat Res. 1991;271:135–42.CrossRef

Makinen TJ, Dhotar HS, Fichman SG, Gunton MJ, Woodside M, Safir O, et al. Periprosthetic supracondylar femoral fractures following knee arthroplasty: a biomechanical comparison of four methods of fixation. Int Orthop. 2015;39:1737–42. https://doi.org/10.1007/s00264-015-2764-0.CrossRefPubMed

Khan S, Schmidt AH. Distal femoral replacement for periprosthetic fractures around total knee arthroplasty: when and how? J Knee Surg. 2019;32:388–91.CrossRef

Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P 3rd. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury. 2012;43:1084–9. https://doi.org/10.1016/j.injury.2012.01.025.CrossRefPubMed

Ebraheim NA, Liu J, Hashmi SZ, Sochacki KR, Moral MZ, Hirschfeld AG. High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties. J Arthroplast. 2012;27:809–13. https://doi.org/10.1016/j.arth.2011.08.007.CrossRef

Liporace FA, Yoon RS. Nail plate combination technique for native and periprosthetic distal femur fractures. J Orthop Trauma. 2019;33:e64–8. https://doi.org/10.1097/BOT.0000000000001332.CrossRefPubMed

Smith WR, Stoneback JW, Morgan SJ, Stahel PF. Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients. Patient Saf Surg. 2016;10:1–5.CrossRef

Berkes MB, Little MT, Lazaro LE, Cymerman RM, Pardee NC, Helfet DL, et al. Intramedullary allograft fibula as a reduction and fixation tool for treatment of complex proximal humerus fractures with diaphyseal extension. J Orthop Trauma. 2014;28:e56–64.CrossRef

10.

Ebraheim NA, Sabry FF, Elgafy H. Intramedullary fibular allograft and nail for treatment of femoral shaft nonunion. Am J Orthop (Belle Mead NJ). 2002;31:270–2.

11.

Elgafy H, Ebraheim NA, Bach HG. Revision internal fixation and nonvascular fibular graft for femoral neck nonunion. J Trauma. 2011;70:169–73. https://doi.org/10.1097/TA.0b013e3181e5108b.CrossRefPubMed

12.

Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma. 2008;22:195–200.CrossRef

13.

Kumar A, Chambers I, Maistrelli G, Wong P. Management of periprosthetic fracture above total knee arthroplasty using intramedullary fibular allograft and plate fixation. J Arthroplasty. 2008;23:554–8.CrossRef

14.

Wang JW, Wang CJ. Supracondylar fractures of the femur above total knee arthroplasties with cortical allograft struts. J Arthroplasty. 2002;17:365–72. https://doi.org/10.1054/arth.2002.31077.CrossRefPubMed

15.

Christ AB, Chawla H, Gausden EB, Villa JC, Wellman DS, Lorich DG, et al. Radiographic and clinical outcomes of periprosthetic distal femur fractures treated with open reduction internal fixation. J Orthop Trauma. 2018;32:515–20. https://doi.org/10.1097/BOT.0000000000001265.CrossRefPubMed

16.

Bernaus M, Slobogean GP, Bzovsky S, Heels-Ansdell D, Zhou Q, Bhandari M, et al. Early radiographic union score for hip is predictive of femoral neck fracture complications within 2 years. J Orthop Trauma. 2020;34:e195–202.CrossRef

17.

Kolmert L, Wulf K. Epidemiology and treatment of distal femoral fractures in adults. Acta Orthop Scand. 1982;53(6):957–62. https://doi.org/10.3109/17453678208992855.CrossRefPubMed

18.

Medda S, Kessler RB, Halvorson JJ, Pilson HT, Babcock S, Carroll EA. Technical trick: dual plate fixation of periprosthetic distal femur fractures. J Orthop Trauma. 2021;35:e148–52. https://doi.org/10.1097/BOT.0000000000001869.CrossRefPubMed

19.

Neer CS. Displaced proximal humeral fractures: Part II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970;52:1090–103.CrossRef

20.

Walch G, Badet R, Nove-Josserand L, Levigne C. Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting. J Shoulder Elbow Surg. 1996;5:161–8. https://doi.org/10.1016/s1058-2746(05)80001-1.CrossRefPubMed

21.

Schliemann B, Wähnert D, Theisen C, Herbort M, Kösters C, Raschke MJ, et al. How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data. Injury. 2015;46:1207–14.CrossRef

22.

Cui X, Chen H, Ma B, Fan W, Li H. Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study. BMC Musculoskelet Disord. 2019;20:511. https://doi.org/10.1186/s12891-019-2907-3.CrossRefPubMedPubMedCentral

23.

Al Farii H, Cloutier JP, AlQahtani S, Kreder H, Mutch J. Endosteal substitution with medial plate in the treatment of acute distal femur fracture (AO/OTA type A): surgical technique and case-series. Eur J Orthop Surg Traumatol. 2021:1–7. https://doi.org/10.1007/s00590-021-02945-x

24.

Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh J. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma. 2011;25:S8–14.CrossRef

25.

Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res. 2013;99:353–60. https://doi.org/10.1016/j.otsr.2012.10.014.CrossRefPubMed

26.

Larsen P, Ceccotti AA, Elsoe R. High mortality following distal femur fractures: a cohort study including three hundred and two distal femur fractures. Int Orthop. 2020;44:173–7. https://doi.org/10.1007/s00264-019-04343-9.CrossRefPubMed

27.

Chen SH, Chiang MC, Hung CH, Lin SC, Chang HW. Finite element comparison of retrograde intramedullary nailing and locking plate fixation with/without an intramedullary allograft for distal femur fracture following total knee arthroplasty. Knee. 2014;21:224–31. https://doi.org/10.1016/j.knee.2013.03.006.CrossRefPubMed

28.

Su ET, DeWal H, Di Cesare PE. Periprosthetic femoral fractures above total knee replacements. J Am Acad Orthop Surg. 2004;12:12–20. https://doi.org/10.5435/00124635-200401000-00003.CrossRefPubMed

29.

Bolhofner BR, Carmen B, Clifford P. The results of open reduction and internal fixation of distal femur fractures using a biologic (indirect) reduction technique. J Orthop Trauma. 1996;10:372–7.CrossRef

30.

Wadhwa H, Salazar BP, Goodnough LH, et al. Distal femur replacement versus open reduction and internal fixation for treatment of periprosthetic distal femur fractures: a systematic review and meta-analysis. J Orthop Trauma. 2022;36:1–6.CrossRef

31.

Springer BD, Sim FH, Hanssen AD, Lewallen DG. The modular segmental kinematic rotating hinge for nonneoplastic limb salvage. Clin Orthop Relat Res. 2004;421:181–7.CrossRef

32.

Unwin P, Cannon S, Grimer R, Kemp H, Sneath R, Walker P. Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br. 1996;78:5–13.CrossRef

33.

Fakler J, Hepp P, Marquaß B, von Dercks N, Josten C. Is distal femoral replacement an adequate therapeutic option after complex fractures of the distal femur? Z Orthop Unfall. 2013;151:173–9.PubMed

Title: Use of an intramedullary fibular strut allograft and dual locking plate in periprosthetic fractures above total knee arthroplasty: new application of a well-known treatment method in trauma
Authors: Dongwhan Suh
Jong-Hun Ji
Jun-Young Heu
Jung-Youn Kim
Heeman Chi
Se-Won Lee
Publication date: 06-03-2022
Publisher: Springer Berlin Heidelberg
Keyword: Periprosthetic Fracture
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-01940-z

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Use of an intramedullary fibular strut allograft and dual locking plate in periprosthetic fractures above total knee arthroplasty: new application of a well-known treatment method in trauma

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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