Case Reports

Periprosthetic Supracondylar Femur Fracture Treated With Spanning External Fixation

Am J Orthop. 2015 February;44(2):90-93

References

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Discussion

Periprosthetic fractures of the femur after TKA often occur in the setting of osteopenia, and some are associated with concurrent implant loosening. In most cases, these fractures require surgical stabilization. Nevertheless, the goals of treatment are to obtain and maintain anatomical alignment and stability to allow early range of motion. Nonoperative options include skeletal traction, cast, pins and plaster, and cast-brace.^3-5,20 Operative options include intramedullary fixation,^12,21 stabilization with various plates,^21-23 revision knee arthroplasty, and arthrodesis.¹ Treatment selection should be based on patient health, fracture displacement, comminution, osteopenia severity, and status of the prosthetic components.

The present case exemplifies some of the highest degrees of medical and surgical risk factors in people with a periprosthetic femoral fracture after TKA. Patients with rheumatoid arthritis, patients having corticosteroid treatment, patients of advanced age, and female patients are all at higher risk for supracondylar femoral fracture.⁹ Our patient had these risk factors on a background of anemia and extensive coronary artery disease. Given her past medical history and refusal of blood products out of religious belief, we thought she was too high risk for extensive surgical treatment for her fracture. In addition, she was not an ideal candidate for nonoperative treatment, as a periprosthetic fracture typically is treated with surgical revision or open reduction and internal fixation. Therefore, we selected an unconventional treatment modality, typically used as a temporizing measure in severe fractures around the knee—a spanning external fixator worn for 6 weeks and a cast-brace for an additional 6 weeks. This led to successful clinical and radiographic outcomes. We consider spanning external fixation a viable option for periprosthetic fractures after TKA in morbidly obese patients with relatively well-aligned fractures and extremely high risk for medical complications associated with traditional open surgery.