Posted: May 27 2020 #(C101476)

TKA Periprosthetic Fracture in a 67F

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HPI

67-year-old obese female presents with severe R knee pain and inability to bear weight after falling down stairs at home. History of bilateral knee replacements performed 8 years prior. Denies pre-existing knee pain prior to the injury.

PMH

Type II diabetes and hypertension

Obese body habitus, Well-healed anterior mid-line knee incision with moderate knee swelling and ecchymosis. Obvious deformity about the knee but the foot is well-vascularized, fully sensate, and patient is able to fire all major muscle groups.

Poll

1 of 10

Would you obtain any additional imaging to guide management?

No - current radiographs are sufficient

29%

(14/47)

Yes - Additonal radiographic views (XR)

(4/47)

Yes - CT scan of the distal femur and knee (CT)

51%

(24/47)

Yes - MRI scan of the distal femur and knee (MRI)

(0/47)

Yes - CT + XR

(3/47)

Yes - MRI + XR

(1/47)

Yes - MRI + CT

(0/47)

Yes - MRI + CT + XR

(0/47)

Outside my area of expertise - best if I don't vote

(1/47)

Would you use a classification system to guide management?

No - a classification system would not help me

33%

(13/39)

Yes - Su and Associates

23%

(9/39)

Yes - Neer

(2/39)

Yes - DiGioia and Rubash

(2/39)

Yes - Chen and Associates

(0/39)

Yes - Lewis and Rorabeck

28%

(11/39)

Outside my area of expertise - best if I don't vote

(2/39)

How would you manage this injury?

Nonoperative

(0/38)

Operative

97%

(37/38)

Outside my area of expertise - best if I don't vote

(1/38)

If you choose Nonoperative management, what type of immobilization would you choose?

I would not choose Nonoperative management

68%

(26/38)

Long-leg cast

10%

(4/38)

Knee immobilizer

10%

(4/38)

Skeletal traction

(3/38)

Outside my area of expertise - best if I don't vote

(1/38)

If you choose Operative management, what surgery would you perform?

I would not choose Operative management

(0/39)

Fixation

79%

(31/39)

Arthroplasty

17%

(7/39)

Outside my area of expertise - best if I don't vote

(1/39)

If you choose Arthroplasty, which prosthesis would you use?

I would not choose Arthroplasty

54%

(20/37)

Long-stemmed revision total knee arthroplasty

35%

(13/37)

Distal femoral replacement

10%

(4/37)

Outside my area of expertise - best if I don't vote

(0/37)

If you choose Fixation, what technique would you select?

I would not choose Fixation

(2/36)

External fixator (includes monoplanar, ringed cricular fixator, etc)

(0/36)

Intramedullary nailing (IMN)

11%

(4/36)

Open reduction internal fixation (ORIF)

77%

(28/36)

ORIF + IMN

(2/36)

Outside my area of expertise - best if I don't vote

(0/36)

If you choose Open reduction internal fixation (ORIF), what construct would you use?

I would not choose ORIF

(1/34)

Non-fixed angle plate(s)

(1/34)

Peri-articular locking plate

88%

(30/34)

Dynamic condylar screw

(2/34)

Blade plate

(0/34)

Outside my area of expertise - best if I don't vote

(0/34)

If you performed Open reduction internal fixation (ORIF) and achieved construct shown below, what would your immediate post-operative weight-bearing status be?

I would not perform ORIF

(0/34)

Non-weight-bearing (NWB)

52%

(18/34)

Toe-touch/touch-down weight-bearing (TTWB)

35%

(12/34)

Partial weight-bearing (PWB) (25-50%)

(3/34)

Weight-bearing as tolerated (WBAT)

(1/34)

Outside my area of expertise - best if I don't vote

(0/34)

If you performed Open reduction internal fixation (ORIF) and achieved construct shown below, what post-operative DVT pharmacoprophylaxis would you use?

I would not perform ORIF

(0/33)

Aspirin

21%

(7/33)

Unfractionated heparin

(1/33)

LMWH (Lovenox)

54%

(18/33)

Coumadin

(0/33)

Direct Xa inhibitor (Apixiban, Rivaroxaban, etc)

21%

(7/33)

Indirect Xa inhibitor (Fondaparinux)

(0/33)

Outside my area of expertise - best if I don't vote

(0/33)

Post-procedure P1

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