Internal fixation of supracondylar fractures after condylar total knee arthroplasty.

Condylar buttress plates were applied in six patients with total knee arthroplasties and supracondylar fractures. According to the criteria of Cain, 50% of the patients had a satisfactory result with an average follow-up period of 17 months. Time to union (full weight bearing) averaged 14 weeks. The final coronal femorotibial alignment averaged 5 degrees of valgus, whereas preoperative valgus had averaged 8 degrees. Four patients were pain free and the two others had minimal pain that did not interfere with daily activity. Knee motion averaged 97 degrees. All patients were ambulating; five of six patients needed two crutches outdoors for reasons unrelated to the index fracture. Four patients had rheumatoid arthritis (RA) with multiple joint involvement, and the fifth was debilitated secondary to old age. No nonunion, loss of fixation, or infection occurred. Open reduction and internal fixation (ORIF) using the condylar buttress plate provides stable fixation, allowing early knee motion and ambulation. If extreme osteoporosis is present, the addition of bone cement enhances screw fixation.