Peri-implant and subsequent proximal femur fractures above distally based supracondylar femoral fixation constructs.

OBJECTIVES

To determine rates of peri-implant and subsequent proximal femur fractures in distally based constructs used to treat supracondylar distal femur fractures.

DESIGN

Retrospective cohort study.

SETTING

Level I Trauma Center, Midwestern United States.

PATIENTS/

PARTICIPANTS

The institutional electronic medical record was used to identify patients with displaced supracondylar femur fractures that were surgically treated with distally based fixation. Exclusion criteria included less than 6 months of follow-up, antegrade fixation, preexisting implants in the proximal femur, and instances where arthroplasty was performed as the initial treatment.

INTERVENTION: Distal femoral plate and/or retrograde intramedullary nail.

MAIN OUTCOME MEASUREMENTS: Rates of peri-implant and subsequent proximal fractures above distally based fixation of supracondylar femur fractures; any additional complications related to prophylactic proximal femoral fixation.

RESULTS

Ninety-four patients were identified who had supracondylar femur fractures treated with distally based constructs; 65 were treated with plating, 25 with retrograde nails, and 4 with a nail-plate combination. After the index distal femoral fracture fixation, 3 patients (3.2%) sustained peri-implant fractures and 5 others (5.3%) had proximal femoral fractures, so that the combined fracture rate adjacent to or above the distally based implants was 8.5%. Prophylactic fixation of the proximal femur above the retrograde implant was performed in 10 patients. Excluding these 10 patients, the subsequent combined peri-implant/proximal femoral fracture rate was 9.5% (8/84). This rate rose to 14.5% in patients over age 60 without prophylactic fixation. There were no complications including subsequent fracture associated with prophylactic fixation of the proximal femur.

CONCLUSIONS

In patients over 60 years of age, the combined incidence of peri-implant and subsequent proximal fracture associated with distally based fixation of supracondylar femur fractures was 14.5% in this series. There were no associated complications with prophylactic fixation.

LEVEL OF EVIDENCE: Level III.