Antao Nicholas A, Londhe Sanjay, Toor Rajan, Shirishkar Rajesh, Aiyer Siddharth
Department of Orthopaedics Holy Spirit Hospital, Jeevan Data Hostel, Mahakali Caves Road, Andheri (E), Mumbai, Maharashtra, 400093, India.
Indian Orthopaedic Research Group, Thane, Maharashtra, 400604, India.
Arthroplasty. 2021 Dec 4;3(1):44. doi: 10.1186/s42836-021-00098-0.
Presence of supracondylar and periarticular femoral fracture with associated arthritis of knee poses a challenging situation to the orthopaedic surgeon. The results of fixation of fracture in osteoporosis are not very satisfactory and have complications. With fixation alone, they still cannot bear weight on affected leg due to severe disability of osteoarthritis. To make patient walk, conventionally three surgeries in the form of fracture fixation, removal of implant and total knee arthroplasty (TKA) needs to be done in staged manner. We propose a novel management in form of bifold fixation and simultaneous TKA.
Eight cases (6 females, 2 males) of supracondylar femoral fractures with severe osteoarthritis of the knee and osteoporosis were primarily fixed with bifold fixation using SIGN nail ( www.signfracturecare.org ) and locking plate together with simultaneous total knee arthroplasty. There were five cases (2 males and 3 females) of grade 4 (Kellgren-Lawrence grading) osteoarthritis (OA) and three cases (all females) of severe rheumatoid arthritis (RA).
The mean age was 68 years and average time for full weight bearing was 6 days. Radiographic evidence of fracture union was achieved in 16.25 weeks. The mean Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 months was 83.13 and 22.13 respectively.
Single stage combined bifold osteosynthesis with interlocking nail and locking plate together with total knee arthroplasty helps in one time management of these difficult injuries. It is a cost-effective and economically sound option and gives excellent results with good patient satisfaction.
股骨髁上及关节周围骨折合并膝关节关节炎给骨科医生带来了具有挑战性的情况。骨质疏松患者骨折固定的效果不太令人满意且存在并发症。仅通过固定，由于骨关节炎导致的严重残疾，患者患侧腿仍无法负重。为了让患者行走，传统上需要分阶段进行三次手术，即骨折固定、取出植入物和全膝关节置换术（TKA）。我们提出了一种采用双折固定和同期TKA的新型治疗方法。
8例（6例女性，2例男性）股骨髁上骨折合并严重膝关节骨关节炎和骨质疏松的患者，首先使用SIGN钉（www.signfracturecare.org）和锁定钢板进行双折固定，并同期进行全膝关节置换术。其中有5例（2例男性和3例女性）为4级（凯尔格伦-劳伦斯分级）骨关节炎（OA），3例（均为女性）为严重类风湿关节炎（RA）。
平均年龄为68岁，完全负重的平均时间为6天。骨折愈合的影像学证据在16.25周时获得。26个月时的平均膝关节协会评分（KSS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分分别为83.13和22.13。
单阶段联合使用带锁髓内钉和锁定钢板的双折骨固定术以及全膝关节置换术有助于一次性处理这些复杂损伤。这是一种经济有效且合理的选择，能取得优异的效果并让患者满意度良好。
