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The Journal of Bone and Joint Surgery, Vol 75, Issue 1 27-34, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Operative treatment of distal femoral fractures proximal to total knee replacements
WL Healy, JM Siliski and SJ Incavo
Department of Orthopaedic Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805.
Twenty fractures of the distal part of the femur proximal to a total knee
replacement were treated operatively by members of the New England Trauma
Study Group. Notching of the anterior aspect of the femoral cortex was
associated with only two of these fractures, and none of the knee
prostheses was loose at the time of the fracture. All twenty fractures were
treated with open reduction and stable internal fixation, and the operation
on fifteen fractures was supplemented with bone grafts. Every fracture
healed, and eighteen healed after a mean of sixteen weeks (range, six to
forty weeks). Union of the other two fractures was delayed, but repeat open
reduction and internal fixation combined with autogenous bone-grafting
resulted in union. After operative treatment, the patients returned to the
level of activity that they had had before the fracture. The pre-existing
tibiofemoral alignment and range of motion of the knee were also restored.
At the time of follow-up, the average clinical rating of the Knee Society
for all twenty knees had not decreased compared with the score before the
fracture.
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