Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Periprosthetic Fractures Adjacent to Total Knee Implants. Treatment and Clinical.

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Presentation transcript:

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Periprosthetic Fractures Adjacent to Total Knee Implants. Treatment and Clinical Results*† by GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am Volume 79(7): July 1, 1997 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-A Photograph showing a condylar split fracture (arrow) that occurred while the box- shaped section was being prepared for insertion of a posterior stabilized implant. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-B Radiograph showing a condylar split fracture (arrowheads). GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2 Radiograph showing a fracture of the tibial shaft (arrowheads). GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3 Illustration12 showing a cortical window made in the femoral condyle, which can be used for impacting bone graft or introducing bone cement to enhance fracture stabilization. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4 Radiograph showing loss of stabilization of a supracondylar fracture because of disruption at the plate-bone junction and varus angulation. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5 Radiograph showing a supracondylar fracture with varus angulation, which may affect the durability of prosthesis. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-A Radiograph, made two weeks postoperatively, showing loss of stabilization a supracondylar of fracture when the supracondylar rod migrated into the knee joint. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-B Radiograph made after a composite consisting of an allograft and a long-stemmed femoral component was used to reconstruct the distal aspect of the femur after stabilization of the fracture with a supracondylar rod had failed (shown in Fig. 6-A). GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-A Radiograph showing a transverse mid-substance fracture of the patella with an unstable patellar component, excision of the unstable bone fragments, and an augmentation repair of the extensor mechanism. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-B Radiograph showing maximum flexion to 80 degrees after repair of the fracture. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 8 Radiograph showing a fracture of the inferior pole of the patella (arrow) with obvious patella alta and abnormal tilt. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 9 Illustration showing reconstruction of the patellar ligament with use of non-absorbable sutures. GERARD A. ENGH, and DEBORAH J. AMMEEN J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.