Femur Fracture Following Tkr

Description: Wheeless Textbook of Orthopaedics Discussion: - known risk factors include notching of the femur, osteoporosis, and excessive polyethylene wear (w/ subsequent osteolytic defect) - Radiographs: - often oblique radiographs are needs as well as AP and Lateral views, due to the rotation of the distal fragment; - lateral radiographs will demonstrate whether the TKR is PCL retaining or sacrificing (the later is more difficult to fix since the intercondylar notch is covered by metal); - Non Operative Treatment: - generally non operative treatment is avoided, except in patients with excessive co-morbidity; - approximately 35% will experience a complication that will require component revision; - 20% non union rate and 23% rate of malunion; - permanent knee stiffness is common; - in the study by Culp et al 1987, one half of patients treated non operatively had increased pain and/or signficant decreased function vs. 13.3% in the control group; - Retrograde Nailing: - advantages include ability to exchange the liner (if necessary) and to insert the nail retrograde thru the intercondylar notch - both thru an anterior approach; - disadvantages - in the case of a closed box posterior stabilized design retrograde nailing will not be possible; - even w/ an open box design, the space available for nail passage is limited (usually less than 14 mm), which often means that under-sized nail will have to be used; - include less than rigid fixation - possibility of stress risers which may lead to mid shaft femoral frx (as has been reported w/ Seligson nails);