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Disclosures
- No financial disclosures, however…
- Dr. Mears is the first traumatologist I ever
worked with
– I agree with whatever he says
- But – there are a lot of ways to skin a cat
I slide a nail past the fracture and get them walking without a - - PowerPoint PPT Presentation
I slide a nail past the fracture and get them walking without a - - PowerPoint PPT Presentation
I slide a nail past the fracture and get them walking without a fatal PE Kristoff Reid, MD Disclosures No financial disclosures, however Dr. Mears is the first traumatologist I ever worked with I agree with whatever he says
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Learning Objectives
- Identify periprosthetic distal femur fractures
suitable for nail
- Understand which total knees can
accommodate a nail
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Which periprosthetic fractures can be nailed?
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Su Classification of periprosthetic distal femur fractures
II I III
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But don’t forget
- You need a space for the nail to go through.
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Don’t end up like this!
Jones 2016
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Why not just plate it?
- Plating works well
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Reasons to think about a nail
- Fracture amenable to early weight bearing
- Medial comminution
- Soft tissue / patient considerations
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But what about PE?
- Little data for this particular question
- Very similar rates for plate vs nail
– White 2003 1.9 vs 1.4 (VTE)
- Rate of fatal PE is very low, even in tumor
population
– Shallop 2015
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What are the outcomes?
- Generally very similar (malunion)
- Some suggestion that operative time and time
to union may be improved with nail.
Shin 2017
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In Summary
- Plates are great!
- But don’t be scared to use a nail
- Just make sure it will fit:
– Jones et al: Retrograde femoral nailing of periprosthetic fractures around total knee replacements. Injury, 2016, 460-464