Minimally Invasive Plate Osteosynthesis for Periprosthetic Distal Femoral Fractures after Total Knee Arthroplasty

PURPOSE: To evaluate the outcomes of the treatment of distal femoral fractures using minimally invasive plate osteosynthesis following total knee arthroplasty (TKA). MATERIALS AND METHODS: From July 2008 to October 2011, 14 patients were treated with minimally invasive plate osteosynthesis for periprosthetic fractures following TKA. The mean duration of follow-up was 19.2 months and the mean age was 69.7 years. Lewis and Rorabeck classification was used to categorize the type of fracture. Pre- and postoperative range of motion, femorotibial angle, and Knee society score, time to bony union, and complications were evaluated. RESULTS: The mean range of motion was 108.4 degrees preoperatively and 107.3 degrees postoperatively. No significant difference was observed in the pre- and postoperative mean range of motion. The average time to bony union was 3.9 months. The knee society score was 82.6 points preoperatively and 78.9 points postoperatively. The mean femorotibial angle was changed from 6.1 degrees valgus postoperatively to 4.6 degrees valgus postoperatively. There was no complication during the follow-up. CONCLUSIONS: Minimally invasive plate fixation for distal femur fractures after TKA showed good results. Minimally invasive plate osteosynthesis is a recommendable treatment method for periprosthetic fractures.

Fixation of the Femoral Subtrochanteric Fracture with Minimally Invasive Reduction Techniques

PURPOSE: To evaluate the results of using minimally invasive reduction techniques in patients with femoral subtrochanteric fracture. MATERIALS AND METHODS: We retrospectively analyzed 40 patients (41 cases) with subtrochanteric fracture who underwent using minimally invasive reduction techniques. The mean age was 61.4 years (15-89 years), and the mean follow-up period was 32.7 months (12-66 months). Clinical results were assessed using the Parker-Palmer mobility score and the Salvati-Wilson hip functional score. Radiographic results were evaluated using bone union time and femur neck-shaft angle. RESULTS: No significant difference was observed in the pre- and postoperative Parker-Palmer mobility score. Salvati-Wilson hip functional score showed more than good grade in 37 cases (90%) at the last follow-up. Union was achieved in all 41 cases at an average of 22.5 weeks (18-30 weeks). The mean femoral neck-shaft angle immediately postoperatively was 128.8 degrees (120-140 degrees), and the mean difference versus contralateral sides was 2.5 degrees varus (-6-13 degrees). CONCLUSION: Fixation of femoral subtrochanteric fracture using minimally invasive reduction techniques showed excellent clinical and radiographic results and low complication rate.

Clinical Outcomes of the Tibia Segmental Fractures Treated by Intramedullary Nail Using Various Reduction Techniques

PURPOSE: We evaluated the clinical outcomes of tibia segmental fractures treated by intramedullary nailing using various reduction techniques. MATERIALS AND METHODS: From January 2003 to June 2009, 18 segmental tibial fracture patients treated by intramedullary nail were enrolled with a minimum 12-month follow-up. The mean follow-up was 38 months (range 15-72). According to the AO classification, the fractures were types 42C2.1, 42C2.2, and 42C2.3 in four, ten, and four patients, respectively. Ten fractures were closed and eight were open. We used various techniques for reduction during operation and investigated bone union time and complication (non-union, malunion etc.). RESULTS: Bone grafting was performed in three patients. Complete union was achieved in all patients. The mean time for union was 16.3 weeks (range 12-21), except in three delayed union patients. All radiological evaluations showed good alignment (less than 5 degree) except in two patients; and the mean deformity angle was 2.2 degree. Knee range of motion (ROM) was 129 degree, and ankle ROM was 68 degree. Local wound infection occurred in two patients. CONCLUSION: Intramedullary nailing is a successful method in the acute management of segmental tibial fractures, if accompanied by appropriate reduction technique.