Ebraheim Nabil A, Carroll Trevor, Bonaventura Bridget, Moral Muhammad Z, Jabaly Youssef G, Liu Jiayong
Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
Orthop Surg. 2014 Aug;6(3):217-22. doi: 10.1111/os.12117.
Treatment of distal femur fractures by long-stemmed total knee arthroplasty (TKA) is challenging, because of poor bone stock, decreased blood supply, history of multiple knee surgeries and an absence of standard treatment. Few published studies are available concerning this. The purpose of this study was to share surgical technique and better describe our patients' comorbidities, which add to the challenge of managing individuals with these fractures.
Between August 2008 and September 2013, seven patients presented to our level I trauma center with distal femoral fractures associated with long-stemmed TKA implants. Their average age was 68.71 years (range, 52-81 years).The most common mechanism of injury was fall (five patients), followed by a traumatic fracture of the femur while walking (one patient), and being lifted out of bed (the one nonambulatory patient). This retrospective study reports a treatment protocol, including surgical technique, and short-term outcome in seven patients in whom locking compression plates (LCP) were used.
Six fractures were classified as Rorabeck type II, and one as type III. The average time to full-weight-bearing was 5.5 months. At this institution, good short-term results have been achieved by using an LCP with screws placed proximal to the long-stem and distal to the fracture. The six patients all achieved full-weight-bearing,taking an average of 5.5 months (range, 3-7 months).
LCP is an effective form of management of distal femur fractures around long stem TKAs. An individualized operative approach possibly incorporating bone-graft substitutes, cerclage wire and a post-operative bone stimulator is recommended.
由于股骨远端骨量差、血供减少、多次膝关节手术史以及缺乏标准治疗方法，采用长柄全膝关节置换术（TKA）治疗股骨远端骨折具有挑战性。关于这方面的已发表研究很少。本研究的目的是分享手术技术，并更好地描述我们患者的合并症，这些合并症增加了处理这些骨折患者的难度。
2008年8月至2013年9月期间，7例患者因股骨远端骨折合并长柄TKA植入物就诊于我们的一级创伤中心。他们的平均年龄为68.71岁（范围52 - 81岁）。最常见的受伤机制是跌倒（5例患者），其次是行走时股骨创伤性骨折（1例患者），以及从床上扶起（1例非行走患者）。这项回顾性研究报告了一种治疗方案，包括手术技术以及7例使用锁定加压钢板（LCP）患者的短期结果。
6例骨折分类为Rorabeck II型，1例为III型。完全负重的平均时间为5.5个月。在本机构，通过在长柄近端和骨折远端放置螺钉的LCP取得了良好的短期效果。6例患者均实现了完全负重，平均用时5.5个月（范围3 - 7个月）。
LCP是治疗长柄TKA周围股骨远端骨折的有效方法。建议采用个体化手术方法，可能包括使用骨移植替代物、环扎钢丝和术后骨刺激器。
