Jankowski Jaclyn M, Zapf Christian G, Hong Ian S, Miceli Joseph G, Yoon Richard S, Liporace Frank A
Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center, Jersey City Medical Center, RWJBarnabas Health Livingston, Jersey City, NJ, United States.
J Clin Orthop Trauma. 2025 Mar 7;64:102969. doi: 10.1016/j.jcot.2025.102969. eCollection 2025 May.
Open reduction and internal fixation for periprosthetic supracondylar femur fractures (PPFx) around a stable total knee arthroplasty (TKA) remains the gold standard, with the nail plate combination (NPC) technique offering increased biomechanical stability and high union rates. Advances in implant technology, particularly the introduction of the novel lateral locking attachment washer (LAW), have increased the availability of NPC options in the treatment of these technically demanding and complex cases. In this technical paper, we discuss two cases: Case 1 - describing the traditional NPC technique utilizing a retrograde intramedullary nail and lateral distal femoral locking plate; Case 2 - describing the NPC technique utilizing a retrograde nail and a novel LAW implant, which is now the authors' more commonly utilized technique. Managing PPFx around a TKA implant remain a challenge, however, the integration of the LAW and newer generation of retrograde intramedullary nails have marked significant progress in treating these complex fractures.
对于稳定的全膝关节置换术（TKA）周围的假体周围股骨髁上骨折（PPFx），切开复位内固定仍然是金标准，钉板组合（NPC）技术具有更高的生物力学稳定性和骨愈合率。植入技术的进步，特别是新型外侧锁定附着垫圈（LAW）的引入，增加了NPC在治疗这些技术要求高且复杂病例中的应用选择。在这篇技术论文中，我们讨论两个病例：病例1——描述使用逆行髓内钉和股骨远端外侧锁定板的传统NPC技术；病例2——描述使用逆行髓内钉和新型LAW植入物的NPC技术，这是作者目前更常用的技术。然而，处理TKA植入物周围的PPFx仍然是一项挑战，LAW与新一代逆行髓内钉的结合在治疗这些复杂骨折方面取得了显著进展。
