Introduction
Epidemiology and pathogenesis
Classification
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Type I: undisplaced fracture and prosthesis is well fixed
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Type II: displaced fracture and prosthesis is well fixed
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Type III: prosthesis is loose, fracture may be displaced or undisplaced
Management
Nonoperative treatment
Operative treatment
Open reduction and internal fixation using conventional plates
Locking plates
Intramedullary fixation
External fixator
Revision total knee arthroplasty
Prosthetic replacement of the distal femur and structural allograft
Fracture type | Description of fracture | Treatment recommendation |
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I | Undisplaced fracture and well-fixed prostheses | Bracing, nonweightbearing |
II | Displaced fracture and well-fixed prostheses | |
A. Good-quality bone | Internal fixation using conventional plate, intramedullary nail or locking plate | |
B. Poor-quality bone with osteopenia and comminution | ||
1. Decent-size distal fragment | Intramedullary nail or locking plate | |
2. Extremely distal fracture | Locking plate or buttress plate with strut allograft | |
III | Displaced fracture, loose prostheses | |
A. No metaphyseal bone loss | Revision knee arthroplasty using a long-stemmed femoral implant | |
B. Metaphyseal bone loss or nonunion following previous surgery | Structural allograft–prostheses composite or distal femoral replacement prosthesis |