Fracturas supracondíleas sobre prótesis total de rodilla

Presentamos 7 casos de fractura del extreme distal del fémur en pacientes con sustitución total de rodilla. El propósito del estudio consiste en valorar las distintas opciones terapéuticas y los resultados obtenidos a medio plazo. Los enfermos fueron tratados quirúrgicamente mediante un clavo intramedular u ortopédicamente con un sistema de tracción de Neufeld de una férula de tipo Q.T.B. El método de tratamiento se decidió en función del grado de desplazamiento de la fractura, tiempo transcurrido desde la misma y estado general del paciente. Todos alcanzaron un nivel de actividad similar al que poseían previo a la fractura.We present 7 cases of supracondylar fracture of the femur in patients with total knee arthroplaty. The purpose of this study was to asses the different options of treatment and their results at mid-term. Fractures were treated with an intramedular nail or with a Neufeld traction system followed by a Q.T.B. cast. The method of treatment depends on the grade of fracture displacement, period of time since the fracture and patient health. All o them reached similar level of activity like before the fracture

Tratamiento de las fracturas periprotésicas de rodilla: revisión de 29 casos

La fractura periprotésica de rodilla es una complicación asociada a una elevada morbilidad y su tratamiento es complejo. El objetivo de este estudio es presentar nuestros resultados en el tratamiento de este tipo de fracturas. Se revisaron un total de 29 casos de fracturas periprotésicas de rodilla. Las fracturas a nivel de fémur se trataron en 7 pacientes con clavo endomedular retrógrado, en 13 con placas bloqueadas, en 2 casos con recambio protésico y en 4 casos se optó por tratamiento ortopédico. A nivel de la tibia los tratamientos empleados fueron el recambio del componente tibial en uno de los pacientes, otro con placa y en uno tratamiento ortopédico. Los resultados fueron buenos en la mayor parte de los pacientes, encontrándose como complicaciones mayores dos casos de retardo de consolidación, un caso de angulación en varo y un caso de infección. Las placas bloquea - das son actualmente la herramienta más versátil y de elección en la mayoría de estas fracturas, con la posibilidad de utilizarlas en cualquier tipo de implante protésico.The periprosthetic fracture of the knee is a complication associated with high morbidity and its treatment is complex. The aim of this study was to present our results in the treatment of these fractures. A total of 29 cases of knee periprosthetic fractures were recorded. In 7 patients the femur fractures were treated with retrograde intramedullary nail, locking plates in 13, in 2 cases with prosthetic replacement and in 4 cases an orthopedic treatment was perform. At the tibia level the treatments included the replacement of the tibial com - ponent in one patient and another with a plate and orthopedic treatment. The results were good for the majority of patients, major complications were find in two cases with delayed union, a case of varus angulation and one infection. The blocking plates are currently the most accepted treatment in most of these fractures with the pos - sibility of using any type of prosthetic implant

Periprosthetic fractures of the femur after total knee arthroplasty

Periprosthetic fracture following total knee arthroplasty is a potentially serious complication. This injury can involve the distal femur, proximal tibia or the patella. This review article analyzes the prevalence, risk factors, classification and treatment options for periprosthetic fractures of the femur

A rare case of periprosthetic supracondylar fracture with fracture medial condyle of femur after total knee arthroplasty

Periprosthetic supracondylar fracture with fracture of medial condyle of femur after total knee arthroplasty (TKA), is of rare incidence. The risk factors include morbid obesity, increased varus deformity after primary TKA, osteopenia, prolonged use of corticosteroids or even trivial trauma leading to stress fractures. We reported a case of periprosthetic supracondylar fracture with fracture medial condyle of right femur after TKA in a patient of rheumatoid arthritis, with severe varus right knee and morbid obesity. X rays of knee revealed the periprosthetic supracondylar fracture with anterior femoral notching; CT scans revealed supracondylar fracture with severe comminuted fracture of right prosthetic medial condyle. Revision arthroplasty was done with augmented long-stem implant and patient was discharged on the 10th post-operative day. Knee movement at 6 months was 0-120 degrees with satisfactory outcome scores on follow-up. Periprosthetic supracondylar fracture with fracture medial condyle of the femoral implant requires immediate diagnosis and treatment; revision arthroplasty is mandatory if associated with morbid obesity, osteopenia and varus knees, after primary TKA. Obesity leads to excessive joint overloading, which together with varus malalignment and poor bone stock, may lead to component loosening, requiring revision arthroplasty. Weight reduction is necessary before primary TKA to improve the functional outcomes and reduce the incidence of revision arthroplasty.

Mono- versus polyaxial locking plates in distal femur fractures – a biomechanical comparison of the Non-Contact-Bridging- (NCB) and the PERILOC-plate

BACKGROUND: The aim of this cadaveric study was to compare a polyaxial (NCB®, Zimmer) to a fixed-angle monoaxial locking plate (PERILOC®, Smith & Nephew) in comminuted fractures of the distal femur regarding stability of the construct. Up to date there is no published biomechanical data concerning polyaxial plating in cadaveric distal femurs. METHODS: Fourteen formalin fixed femora were scanned by dual-energy x-ray absorptiometry. As fracture model an unstable supracondylar comminuted fracture was simulated. Fractures were pairwise randomly fixed either with a mono- (group A) or a polyaxial (group B) distal femur plate. The samples were tested in a servohydraulic mechanical testing system starting with an axial loading of 200 N following an increase of 200 N in every step with 500 cycles in every sequence up to a maximum of 2 000 N. The end points were implant failure or relevant loss of reduction. Data records included for each specimen time, number of cycles, axial load and axial displacement. Statistical analysis was performed using the exact Wilcoxon signed rank test. RESULTS: The mean donor age at the time of death was 75 years. The bone mass density (BMD) of the femurs in both groups was comparable and showed no statistically significant differences. Five bones failed before reaching the maximum applied force of 2000 N. Distribution curves of all samples in both groups, showing the plastic deformation in relation to the axial force, showed no statistically significant differences. CONCLUSIONS: Operative stabilization of distal femur fractures can be successfully and equally well achieved using either a monoaxial or a polyaxial locking plate. Polyaxial screw fixation may have advantages if intramedullary implants are present. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2474-15-369) contains supplementary material, which is available to authorized users

Influencia de los Factores Biomecánicos en las Fracturas Periprotésicas de Rodilla

Al mismo tiempo que aumenta el número de cirugías de Prótesis total de rodilla, también lo hace el número de complicaciones. Las fracturas periprotésicas son una de las complicaciones más graves, relacionadas con múltiples factores de riesgo. El objetivo de esta Tesis es realizar una revisión actualizada sobre este tipo de fracturas y analizar dos factores biomecánicos. Estos factores son: 1) El Índice de Masa Corporal, que no se relaciona con la aparición de fracturas. 2) El Notch femoral, que se demuestra no estar relacionado con el patrón de fractura.While total knee replacement surgeries are increasing, so does the number of complications. One of the most severe is Periprosthetic fracture, which is related to many risk factors. The aim of this Doctoral Thesis is to update our knowledge about this kind of fractures and to analyze two of the main biomechanical factors. These factors are: 1) The Body Mass Index, which is not related to the appearance of fractures. 2) Anterior femoral notch, which is shown not to be related to the fracture pattern.Tesis Univ. Jaén. Departamento de Ciencias de la Salud. Leída el 6 de abril de 2018

Distal femur fractures in adults

Fractures of the distal femur occur in a bimodal age distribution. Many are complicated by intra-articular extension and comminution. Periprosthetic fractures add to the complexity of their management. Open fractures can occur with high energy trauma. Surgical treatment is the standard of care, with fixed angle plate fixation and intramedullary nailing being the most common techniques used. Surgical management can be technically challenging. Complications include malunion, delayed union, non-union and implant failure. Persistent disability and poor clinical outcome often results. Despite the development of modern implants, no clear advantage exists for one particular implant and some poorer outcomes may relate to the surgical technique applied to management. Knowledge and correct application of the principles of fracture management are required to optimize the chance of successful outcome. This article will discuss the epidemiology, anatomy, management and surgical techniques for distal femur fractures and review the evidence for the different surgical options