|dc.description.abstract||Background. Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures remains a difficult challenge for orthopedic surgeons. Previous case series have shown distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and provide stability. However, bilateral injury treated with single stage DFR is rarely encountered and to our knowledge, there are no case reports in the literature. We present a patient with traumatic open left Su III/Rorabeck III periprosthetic distal femur fracture and closed right comminuted intraarticular distal femur fracture with end-stage arthrosis treated with bilateral DFR. We suggest that in elderly patients with similar injuries bilateral DFR can be a viable treatment option.
Case Information. An 80-year-old female with past surgical history of left TKA in 2005 presented to our hospital after being involved in a motor vehicle collision resulting in open left periprosthetic distal femur fracture and a closed comminuted right intraarticular distal femur fracture with end-stage arthrosis. She also had a history of anemia and end-stage right knee arthritis for which she was planning a TKA in 2017. She was admitted by our geriatric trauma service for medical optimization prior to surgery.
The on-call operative team planned open reduction internal fixation of the open left periprosthetic distal femur fracture after obtaining XR and CT. After making a lateral approach to the femur her fracture was found to be more comminuted than anticipated and the bone-prosthesis interface was not intact. An intraoperative decision was made to place an external fixator with referral to the arthroplasty service for evaluation for possible DFR. For the right distal femur fracture, closed reduction was performed with placement of a knee immobilizer. The patient was taken to the operating room on the 7th day post-admission for bilateral DFR.
Postoperatively the patient was made weight bearing as tolerated to both lower extremities and worked with physical therapy daily. She is driving, maintaining her home, and living independently. On exam, her surgical incisions are well healed without evidence of infection. Knee range of motion is from 0-110 degrees bilaterally. One-year postoperative radiographs were obtained demonstrating unchanged alignment of her previously placed prostheses with no signs of loosening
Conclusion. Bilateral DFR is a viable treatment option for Su III periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis. We suggest that in elderly patients with similar injuries, bilateral DFR can effectively compensate for bone loss, relieve knee pain, provide stability, and allow for earlier mobilization resulting in satisfactory patient outcomes.||