The use of the supracondylar nail in the management of femoral fractures in the presence of other femoral implants in the very elderly.

In a retrospective study we review the use of the supracondylar nail for the treatment of distal femoral fractures above existing knee prostheses or below upper femoral implants in a very elderly population of mean age 85. Over a 2 year period we have used the Smith and Nephew supracondylar nail to stabilise seven distal third femoral fractures either distal to a femoral implant (six cases) or proximal to a total knee replacement. One patient died soon after surgery, one patient had an extension of the fracture proximal to the nail but the others made an excellent functional recovery with early mobilisation of the knee. We recommend the use of the supracondylar nail in the management of these difficult cases. The very elderly patient benefits from the early and stable fixation of these fractures.