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TKA Periprosthetic Fracture
Posted: Oct 28 2022 #(C102094)
A

TKA Periprosthetic Fracture in 75M

HPI

A 75 year-old male presents after sustaining a fall due to a slip on the wet floors of a grocery store. Prior to the fall, the patient had a well-functioning TKA done in 2015. The implant is an open box Stelkast. The patient is moderately active. He only complains of isolated right knee pain currently.

PMH

None

PE

Focused examination of the right knee demonstrates that the patient is unable to ambulate. Hip ROM is non-painful. He has sustained no other injuries and his skin is intact. Patient is neurovascularly intact.

Poll
1 of 9
1. In addition to the AP + Lat radiographs of the femur (includes hip and knee joint), would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
27%
223/805
Yes - addition radiographs (aXR)
2%
23/805
Yes - CT
62%
502/805
Yes - MRI
0%
8/805
Yes - aXR + CT
3%
25/805
Yes - aXR + MRI
0%
1/805
Yes - CT + MRI
0%
6/805
Yes - aXR + CT + MRI
0%
2/805
Outside my area of expertise - best if I don't vote
1%
15/805
2. How would you manage this injury?
Nonoperative
0%
7/781
Operative
98%
769/781
Outside my area of expertise
0%
5/781
3. If you choose Operative management, what treatment would you perform?
I would not choose Operative management
0%
1/785
ORIF with Plate(s) Alone
54%
430/785
Intramedullary Nail (IMN) Alone
11%
87/785
ORIF with Plate(s) + IMN (Nail Plate Combo)
13%
103/785
Revision Arthroplasty (rTKA) (includes DFR) Alone
11%
89/785
ORIF with Plate(s) + rTKA
6%
49/785
IMN + rTKA
1%
8/785
External fixation (ExFix) Alone
0%
1/785
Outside my area of expertise - best if I don't vote
2%
17/785
4. If you choose ORIF with Plate(s) Alone, which plate construct would you use?
I would not choose ORIF with Plate(s) Alone
7%
57/741
Lateral plate fixation Alone
64%
477/741
Medial plate fixation Alone
2%
21/741
Lateral + Medial plate fixation
23%
172/741
Outside of my area of expertise - best I don't answer
1%
14/741
5. If you choose ORIF with Lateral plate fixation Alone, what approach would you use?
I would not chose ORIF with Lateral plate fixation Alone
8%
63/717
Lateral - Vastus splitting
25%
182/717
Lateral - Subvastus (extensile, Bastia splitting)
24%
175/717
Lateral - Submuscular plating (MIPO)
38%
276/717
Outside my area of expertise - best if I don't vote
2%
21/717
6. If you chose ORIF with Lateral plate fixation Alone, what type of plate would you use?
I would not chose ORIF with Lateral plate fixation only
6%
49/703
Blade plate - blade proximal
0%
1/703
Blade plate - blade distal
0%
6/703
Locking plate - Proximal femoral locking
2%
21/703
Locking plate - Distal femoral locking
83%
584/703
Condylar buttress plate (non-locking)
2%
19/703
Dynamic condylar screw
0%
3/703
Large Fragment Plate
0%
6/703
Outside my area of expertise - best if I don't vote
1%
14/703
7. If you choose ORIF with Plate + IMN, what post-operative weight-bearing status would you assign the patient?
I would not choose ORIF + IMN
23%
156/655
Non-weight-bearing (NWB)
7%
52/655
Touch down weight-bearing (TDWB)
22%
149/655
Partial weight bearing (PWB, < 25-50%)
20%
136/655
Weight-bearing as tolerated (WBAT)
23%
154/655
Outside my area of expertise - best if I don't vote
1%
8/655
8. If you choose ORIF Alone with lateral plate and obtained the construct shown below, what DVT prophylaxis would you prescribe?
I would not choose ORIF Alone with lateral plate
2%
19/663
Aspirin
26%
176/663
Low molecular weight heparin (Lovenox)
54%
364/663
Heparin transitioned to Coumadin
1%
7/663
Xa inhibitors (Xarelto etc.)
13%
87/663
Outside my area of expertise - best if I don't vote
1%
10/663
9. If you choose ORIF Alone with Lateral plate fixation and obtained the construct below, and the patient had delayed union seen on radiographs, what time point would you declare nonunion?
I would not choose ORIF Alone with Lateral plate
2%
15/661
3 months
11%
73/661
4 months
5%
35/661
5 months
1%
12/661
6 months
53%
355/661
9 months
18%
121/661
12 months
6%
40/661
Outside of my area of expertise - best if I don't vote
1%
10/661
PROCEDURE #1

ORIF RIGHT FEMUR

POLL#
Surgeon's Choices
1
In addition to the AP + Lat radiographs of the femur (includes hip and knee joint), would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
2
How would you manage this injury?
Operative
3
If you choose Operative management, what treatment would you perform?
ORIF with Plate(s) Alone
4
If you choose ORIF with Plate(s) Alone, which plate construct would you use?
Lateral plate fixation Alone
5
If you choose ORIF with Lateral plate fixation Alone, what approach would you use?
Lateral - Submuscular plating (MIPO)
6
If you chose ORIF with Lateral plate fixation Alone, what type of plate would you use?
Locking plate - Distal femoral locking
7
If you choose ORIF with Plate + IMN, what post-operative weight-bearing status would you assign the patient?
Weight-bearing as tolerated (WBAT)
8
If you choose ORIF Alone with lateral plate and obtained the construct shown below, what DVT prophylaxis would you prescribe?
Aspirin
9
If you choose ORIF Alone with Lateral plate fixation and obtained the construct below, and the patient had delayed union seen on radiographs, what time point would you declare nonunion?
6 months
Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
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