This systematic review pooled 10 years of literature on periprosthetic distal femur fractures after TKA. It asked which fracture types are most common and which treatments produce the best outcomes. Data from 41 studies covering 1068 fractures were organized by fracture classification and treatment method.
When a TKA patient comes in after a fall with distal femur pain, your first classification decision is Rorabeck: is the fracture displaced, and is the prosthesis stable? That single question determines the operative strategy.
For the most common scenario — Rorabeck type II with a stable implant. Both locking plate and retrograde IMN get the fracture to heal at similar rates. The complication data here tip the balance: locking plate carries an 18% lower complication rate (35% vs 53%), making it the preferred construct when anatomy allows.
If the prosthesis is loose or failing (Rorabeck type III), internal fixation is not the answer. Revision arthroplasty is the appropriate path, and this review's data support that approach with 100% union in the small revision arthroplasty cohort for types III and higher-complexity AO/OTA patterns.
One nuance worth knowing: retrograde IMN requires an open intercondylar notch in the femoral component. Confirming implant design on preoperative imaging is a mandatory step before planning nail fixation.
This systematic review pooled 10 years of literature on periprosthetic distal femur fractures after TKA. It asked which fracture types are most common and which treatments produce the best outcomes. Data from 41 studies covering 1068 fractures were organized by fracture classification and treatment method.
When a TKA patient comes in after a fall with distal femur pain, your first classification decision is Rorabeck: is the fracture displaced, and is the prosthesis stable? That single question determines the operative strategy.
For the most common scenario — Rorabeck type II with a stable implant. Both locking plate and retrograde IMN get the fracture to heal at similar rates. The complication data here tip the balance: locking plate carries an 18% lower complication rate (35% vs 53%), making it the preferred construct when anatomy allows.
If the prosthesis is loose or failing (Rorabeck type III), internal fixation is not the answer. Revision arthroplasty is the appropriate path, and this review's data support that approach with 100% union in the small revision arthroplasty cohort for types III and higher-complexity AO/OTA patterns.
One nuance worth knowing: retrograde IMN requires an open intercondylar notch in the femoral component. Confirming implant design on preoperative imaging is a mandatory step before planning nail fixation.