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INTRODUCTIONAs the number of elderly age patients who undergo arthroplasty increases, periprostheticfracture occurs more frequently and its treatment often requires various fixation techniques dueto severe osteoporosis. Many effective devices and methods have been reported to treatperiprosthetic fractures. The purpose of this paper is to evaluate the effectiveness ofintramedullary supracondylar (IMSC) nail utilized in the supracondylar femoral fracturefollowing total knee arthroplasty (TKA) in elderly age patients.PATIENS AND METHODSA total of 3 supracondylar femoral fracture patients with TKA history were operated with IMSCnail. All cases were female and the average age at the time of the fracture was 84.6 (range 77-91). The fracture occurred on average 4 years after TKA(range 2.9-4.7). We investigated thepatients’ pre and postoperative ambulatory status and the duration till femoral fusion after thesurgery.RESULTSAll results are shown in Figure 1. A total of 2 patients who were ambulatory before fracturemaintained ambulate status with or without T-cane after surgery. The remaining one case was a91 years old and had no ambulatory status before surgery. The average duration till fusion was 9weeks (range 6-12).DISCUSSIONRecently, various surgical options for the treatment of periprosthetic fractures were suggested,such as intramedullary nail, minimally invasive plate osteosynthesis (MIPO). When IMSC nailis selected, the size, intercondylar distance of the femoral component, and the location of thefracture site should be investigated preoperatively. A minimum of 11 mm for intercondylardistance is usually required to insert the nail. Almost all femoral components have enoughintercondylar distance and space for determining the insertion point of the nail. Moreover, extracare on preoperative implant retrieval is necessary on some femoral implants with intercondylarclosed box design.Each total knee system has different component design in anterior-posterior, medial-lateraldimension of the intercondylar space, the location and height of the tibial polyethylene insertionpost. These factors pose considerable limitations on the insertion point and angle of the nail.Often, knee after IMSC nail fixation tends to hyper-extend slightly due to the limitationsabovementioned. MIPO could be performed to reduce this postoperative deformity. Thismethod makes anatomical reduction possible regardless of the femoral component design andcomparative rigid fixation can be obtained utilizing locking screws in osteoporotic patients. Incases with wide knee range of motion (ROM), MIPO is considered first choice to maintain thepostoperative ROM. In this series, all patients did not have active ambulate status and wideknee ROM. Thus, IMSC nails were preferred for its simplicity.Various factors such as patient’s preoperative activity, fracture type, and implant design shouldbe carefully evaluated preoperatively case by case for optimum treatment.Figuresfile:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]