Fractures about the knee in thegeriatric patient: fix them or replace them?

Abstract

Displaced fractures of the distal femur are conventionally treated with open reduction and internal fixation to restore joint congruity, regain alignment, establish bony support, and retain limb function. Successful treatment with this approach preserves bone and maintains the native cartilage-bearing joint. However, fractures of the distal femur in the geriatric population are associated with a high incidence of postoperative complications and poor results. Nonunion, loss of fixation, and malunion of these fractures occur with many types of treatment. Many patients have preexisting osteoarthritis, which, even with successful fracture healing guarantees poor functional results. In addition, the postoperative management of these patients demands a lengthy period of limitation of weight bearing, which can increase the rate of many medical complications and overall loss of independence. Experience with these challenging fractures has led to an alternative approach utilizing a primary distal femur replacement total knee arthroplasty. These prosthesis, originally designed for tumor reconstruction, offer many advantages over open reduction of these fractures, including elimination of fracture healing issues, early mobilization, and immediate weight bearing. Potential disadvantages include concerns over longevity and cost of hardware, and surgeon inexperience with these implants.