Management of Distal Femoral Periprosthetic Fractures: Plate, Intramedullary Nail or Arthroplasty?

Whilst fractures around a knee replacement are uncommon, their incidence can be expected to increase in line with the increase in primary knee arthroplasty procedures being performed. These patients are often elderly and these injuries represent fragility fractures. The challenges of treating this patient and injury are significant. There is no consensus on which modality of treatment is best for treating the periprosthetic distal femoral fracture. Most fractures present with displacement but without loosening or compromise of the implant, these are amenable to fixation. Modalities of fixation have improved with an increase in understanding of fracture biology and improvements in technology, and locking plates, intramedullary nails, and combinations of both are being used. Fractures with poor or inadequate bone stock or a loose prosthesis may necessitate treatment with an endoprosthetic replacement.