This systematic review of 44 studies (719 fractures) compares nonoperative care, conventional plating, RIMN, and locked plating for periprosthetic distal femur fractures above TKAs — asking which fixation strategy best minimizes malunion, nonunion, and reoperations.
When managing a periprosthetic distal femur fracture above a TKA with stable components and adequate distal bone stock, locked plating is favored over RIMN if maintaining alignment is the primary concern — but monitor for nonunion, as RIMN may carry a biologic union advantage that this review could not confirm at statistical significance.
This systematic review of 44 studies (719 fractures) compares nonoperative care, conventional plating, RIMN, and locked plating for periprosthetic distal femur fractures above TKAs — asking which fixation strategy best minimizes malunion, nonunion, and reoperations.
When managing a periprosthetic distal femur fracture above a TKA with stable components and adequate distal bone stock, locked plating is favored over RIMN if maintaining alignment is the primary concern — but monitor for nonunion, as RIMN may carry a biologic union advantage that this review could not confirm at statistical significance.