• OBJECTIVES
    • To determine rates of peri-implant and subsequent proximal femur fractures in distally based constructs used to treat supracondylar distal femur fractures.
  • DESIGN
    • Retrospective cohort study.
  • SETTING
    • Level I Trauma Center, Midwestern United States.
  • PATIENTS/PARTICIPANTS
    • The institutional electronic medical record was used to identify patients with displaced supracondylar femur fractures that were surgically treated with distally based fixation. Exclusion criteria included less than 6 months of follow-up, antegrade fixation, preexisting implants in the proximal femur, and instances where arthroplasty was performed as the initial treatment.
  • INTERVENTION
    • Distal femoral plate and/or retrograde intramedullary nail.
  • MAIN OUTCOME MEASUREMENTS
    • Rates of peri-implant and subsequent proximal fractures above distally based fixation of supracondylar femur fractures; any additional complications related to prophylactic proximal femoral fixation.
  • RESULTS
    • Ninety-four patients were identified who had supracondylar femur fractures treated with distally based constructs; 65 were treated with plating, 25 with retrograde nails, and 4 with a nail-plate combination. After the index distal femoral fracture fixation, 3 patients (3.2%) sustained peri-implant fractures and 5 others (5.3%) had proximal femoral fractures, so that the combined fracture rate adjacent to or above the distally based implants was 8.5%. Prophylactic fixation of the proximal femur above the retrograde implant was performed in 10 patients. Excluding these 10 patients, the subsequent combined peri-implant/proximal femoral fracture rate was 9.5% (8/84). This rate rose to 14.5% in patients over age 60 without prophylactic fixation. There were no complications including subsequent fracture associated with prophylactic fixation of the proximal femur.
  • CONCLUSIONS
    • In patients over 60 years of age, the combined incidence of peri-implant and subsequent proximal fracture associated with distally based fixation of supracondylar femur fractures was 14.5% in this series. There were no associated complications with prophylactic fixation.
  • LEVEL OF EVIDENCE
    • Level III.