Nagwadia Hasmukh, Joshi Prateek
Department of Orthopaedics, Shalby Hospital, Opp. Karnavati Club S G Road, Ahmedabad, Gujarat, 380015, India.
Department of Orthopaedics, Atharva Orthopaedic Superspeciality Hospital, New Vadaj, Ahmedabad, Gujarat, 380013, India.
Eur J Orthop Surg Traumatol. 2018 May;28(4):683-690. doi: 10.1007/s00590-017-2121-7. Epub 2018 Jan 3.
Incidence of periprosthetic fractures around knee is going to rise in near future due to dramatic increase in total knee arthroplasty (TKA). Our study is a retrospective case series describing the outcome of osteosynthesis for periprosthetic fractures after TKA.
We analyzed the outcome of osteosynthesis for periprosthetic fractures with stable implants in 43 patients having 45 fractures operated between 2010 and 2015.
Out of 43 patients, the majority were female (M-15, F-28) with mean age of 65.95 years, majority had left knee involved (L-24, R-19), with fractures involving femur, tibia and patella, respectively, in 29, 11 and 5 patients. Fracture pattern was Rorabeck type 2 in 29, Felix type 2 in 6, type 3 in 5, Goldberg type 2 in 3, type 3a in 2, Unified classification system type A in 2, B1 in 35, C in 4, E in 2 cases. Anterior femoral cortex notching was found in 13 patients with femoral fractures. According to Tayside classification, 12 patients had type 1 and one had type 2 notching. Different implants were used according to the need of the fractures. After TKA, the mean Hospital for Special Surgery score was 84.2, which reduced to mean 76 at 9 months following osteosynthesis. Three patients had nonunion, one had delayed union and one had implant failure.
Osteosynthesis for periprosthetic fractures around knee with locked compression plate gives promising results. Fractures involving patella are associated with inferior functional outcome. Understanding the fracture pattern and bone stock available for fixation with correct choice of implant and correct surgical technique gives promising outcome in periprosthetic fractures around knee.
由于全膝关节置换术（TKA）的急剧增加，膝关节周围假体周围骨折的发生率在不久的将来将会上升。我们的研究是一个回顾性病例系列，描述了TKA后假体周围骨折的骨固定结果。
我们分析了2010年至2015年间43例患者45处骨折采用稳定植入物进行骨固定的结果。
43例患者中，大多数为女性（男性15例，女性28例），平均年龄65.95岁，大多数累及左膝（左膝24例，右膝19例），分别有29例、11例和5例患者的骨折累及股骨、胫骨和髌骨。骨折类型为Rorabeck 2型29例，Felix 2型6例，3型5例，Goldberg 2型3例，3a型2例，统一分类系统A型2例，B1型35例，C型4例，E型2例。13例股骨骨折患者发现股骨前皮质有切迹。根据泰赛德分类，12例患者为1型切迹，1例为2型切迹。根据骨折需要使用不同的植入物。TKA后，特殊外科医院平均评分为84.2分，骨固定术后9个月降至平均76分。3例患者出现骨不连，1例出现延迟愈合，1例出现植入物失败。
采用锁定加压钢板对膝关节周围假体周围骨折进行骨固定取得了良好的效果。累及髌骨的骨折与功能预后较差有关。了解骨折类型和可用于固定的骨量，正确选择植入物和正确的手术技术，对于膝关节周围假体周围骨折可取得良好的预后。
