Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12328
Peer-review started: July 10, 2022
First decision: September 5, 2022
Revised: September 16, 2022
Accepted: October 26, 2022
Article in press: October 26, 2022
Published online: November 26, 2022
Processing time: 136 Days and 4.2 Hours
Periprosthetic supracondylar femoral fractures (PSFs) present a challenge in terms of optimizing fixation in patients with poor bone quality. Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons. Among different treatment options, locking plate (LP) and retrograde intramedullary nail (RIMN) have shown favorable results. However, reduced mobility and protected weight-bearing are often present in the postoperative older population. With a purpose of allowing for early weight-bearing, a modified nail plate combination (NPC) was redesigned for PSF management.
In our cases, two elderly osteoporotic female underwent total knee arthroplasty (TKA), and then suffered from low energy trauma onto their knees after falling to the floor. Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs, both of which occurred at the distal femur above TKA. The modified NPC technique was performed for treatment of PSFs. The patient was made foot flat weight bearing in 1 wk. At 6-mo follow-up, the union was ultimately achieved using modified NPC with satisfactory implant outcomes.
Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone. Therefore, developing a modified implant offer an alternative choice for treating PSFs. These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs, offering safe, early weight bearing and favorable clinical outcomes.
Core Tip: In this article, we reported two cases of elderly osteoporotic patients with periprosthetic supracondylar femoral fractures (PSFs) in the setting of total knee arthroplasty (TKA) after treated with modified nail plate combination (NPC), which was granted by the Trademark Office of China National Intellectual Property Administration. Unlike inserting retrograde intramedullary nail (RIMN) for holding the reduction after the initial reduction of fragments in previous NPC cases, it is the modified locking plate (LP) that performs the initial reduction and fixation of the distal femoral fragments in our cases. Initial reduction and fixation with LP and then insertion of RIMN can avoid an extension deformity in nailing of PSFs due to the femoral component of the TKA occluding the optimal start point. In patients with osteoporosis, modified NPC is beneficial and effective, attributed to early weight bearing and favorable clinical outcomes.