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TKA Periprosthetic Fracture
Posted: May 27 2020 #(C101476)
B

TKA Periprosthetic Fracture in a 67F

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

PE

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
1. Would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
30%
15/50
Yes - Additonal radiographic views (XR)
8%
4/50
Yes - CT scan of the distal femur and knee (CT)
50%
25/50
Yes - MRI scan of the distal femur and knee (MRI)
0%
0/50
Yes - CT + XR
8%
4/50
Yes - MRI + XR
2%
1/50
Yes - MRI + CT
0%
0/50
Yes - MRI + CT + XR
0%
0/50
Outside my area of expertise - best if I don't vote
2%
1/50
2. Would you use a classification system to guide management?
No - a classification system would not help me
33%
14/42
Yes - Su and Associates
21%
9/42
Yes - Neer
4%
2/42
Yes - DiGioia and Rubash
4%
2/42
Yes - Chen and Associates
0%
0/42
Yes - Lewis and Rorabeck
28%
12/42
Outside my area of expertise - best if I don't vote
7%
3/42
3. How would you manage this injury?
Nonoperative
0%
0/41
Operative
97%
40/41
Outside my area of expertise - best if I don't vote
2%
1/41
4. If you choose Nonoperative management, what type of immobilization would you choose?
I would not choose Nonoperative management
65%
27/41
Long-leg cast
9%
4/41
Knee immobilizer
14%
6/41
Skeletal traction
7%
3/41
Outside my area of expertise - best if I don't vote
2%
1/41
5. If you choose Operative management, what surgery would you perform?
I would not choose Operative management
0%
0/42
Fixation
78%
33/42
Arthroplasty
19%
8/42
Outside my area of expertise - best if I don't vote
2%
1/42
6. If you choose Arthroplasty, which prosthesis would you use?
I would not choose Arthroplasty
52%
21/40
Long-stemmed revision total knee arthroplasty
35%
14/40
Distal femoral replacement
12%
5/40
Outside my area of expertise - best if I don't vote
0%
0/40
7. If you choose Fixation, what technique would you select?
I would not choose Fixation
7%
3/39
External fixator (includes monoplanar, ringed cricular fixator, etc)
0%
0/39
Intramedullary nailing (IMN)
12%
5/39
Open reduction internal fixation (ORIF)
74%
29/39
ORIF + IMN
5%
2/39
Outside my area of expertise - best if I don't vote
0%
0/39
8. If you choose Open reduction internal fixation (ORIF), what construct would you use?
I would not choose ORIF
5%
2/37
Non-fixed angle plate(s)
2%
1/37
Peri-articular locking plate
83%
31/37
Dynamic condylar screw
5%
2/37
Blade plate
0%
0/37
Outside my area of expertise - best if I don't vote
2%
1/37
9. 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%
0/37
Non-weight-bearing (NWB)
48%
18/37
Toe-touch/touch-down weight-bearing (TTWB)
37%
14/37
Partial weight-bearing (PWB) (25-50%)
10%
4/37
Weight-bearing as tolerated (WBAT)
2%
1/37
Outside my area of expertise - best if I don't vote
0%
0/37
10. 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%
0/36
Aspirin
25%
9/36
Unfractionated heparin
2%
1/36
LMWH (Lovenox)
52%
19/36
Coumadin
0%
0/36
Direct Xa inhibitor (Apixiban, Rivaroxaban, etc)
19%
7/36
Indirect Xa inhibitor (Fondaparinux)
0%
0/36
Outside my area of expertise - best if I don't vote
0%
0/36
PROCEDURE #1

Open reduction internal fixation using a supracondylar peri-articular locking plate

icon
OUTCOMES
Post-procedure P1
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