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Periprosthetic distal femur fractures treated by retrograde intramedullary nails with a 10-degree distal bend achieve significantly better post-operative radiographic alignment when compared to conventional retrograde nails

  • Matthew S. Kerr
    Correspondence
    Corresponding author.
    Affiliations
    Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
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  • Everett G. Young
    Affiliations
    Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
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  • M. Kareem Shaath
    Affiliations
    Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
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  • Frank R. Avilucea
    Affiliations
    Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
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  • Obinna O. Adigweme
    Affiliations
    Orlando Orthopaedic Center, University of Central Florida College of Medicine, 25W Crystal Lake Street Suite 200, Orlando, FL 32806, United States
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  • George J. Haidukewych
    Affiliations
    Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States
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Published:November 11, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.029

      Highlights

      • Outside of a case report previously published by our institution, this is the first study to describe the use of a novel implant in the treatment of periprosthetic distal femur fractures.
      • We demonstrate that the use of a novel retrograde intramedullary nail with a 10° distal bend results in significantly better post-operative sagittal alignment than conventional nails with a 5° following treatment for periprosthetic distal femur fractures.
      • We demonstrate no difference in post-operative coronal alignment when comparing the novel retrograde intramedullary nail to conventional nails in the treatment of periprosthetic distal femur fractures.

      Abstract

      Introduction

      Periprosthetic distal femur fractures (PPDFFs) are a common complication after total knee arthroplasty (TKA). In the setting of well-fixed TKA components, treatment options include retrograde intramedullary nailing (rIMN) or lateral locked plating. Treatment with rIMN has historically been associated with potential for extension deformity when using conventional nails. We hypothesized that the PPDFFs treated with an intramedullary nail with a specifically designed 10-degree distal bend for periprosthetic fractures would result in improved post-operative sagittal alignment compared to conventional intramedullary nails.

      Materials and methods

      The study was conducted at a level-1 trauma center over a 12-year period (2010 - 2022). Patients over the age of 18 who sustained a PPDFF treated with rIMN were identified. The primary outcomes of the study were post-operative coronal and sagittal alignment determined by reviewing post-operative radiographs.

      Results

      A total of 50 patients were included. Twenty-three patients were treated with a rIMN with a 10° distal bend. Twenty-seven patients were treated with a rIMN with distal bend of 5° The mean aPDFA for the 10° distal bend group was 81.7° compared to 92.8° in the 5° distal bend group (p<0.001). There were 3/23 (13%) significant sagittal plane deformities the 10° distal bend group compared to 11/27 (41%) in the 5° distal bend group (p = 0.03). There was one patient with a post-operative extension deformity in the 10° distal bend group compared to 11 patients in the 5° distal bend group (p = 0.02).

      Conclusion

      Retrograde intramedullary nailing of PPDFF with a 10° distal bend results in significantly better alignment in the sagittal plane when compared to a conventional 5° nail. The use of a 5° nail resulted in an extension deformity significantly more frequently. We therefore recommend the utilization of a rIMN with a 10° distal bend when treating PPDFFs.

      Summary

      Periprosthetic distal femur fractures are a common complication following total knee arthroplasty. While several studies report on the use of retrograde intramedullary nails in the treatment of periprosthetic distal femur fractures, there are limited reports of the use of a novel retrograde intramedullary nail with a 10° distal bend in the treatment of these injuries. Herein we present a radiographic study comparing coronal and sagittal postoperative alignment following treatment with retrograde intramedullary nails with a 10° distal bend versus conventional retrograde nails with a 5° distal bend.

      Keywords

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