Type A: inferior pole fracture with patellar ligament ruptureType B: inferior pole fracture without patellar ligament rupture
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A 72-year-old woman sustains a fall onto her knee three years after an uncomplicated total knee replacement. The fracture pattern is seen in Figure A. The operative note reveals that a cemented patellar component was used. On exam, she has a large effusion and an inability to straight leg raise. If the patellar component is well fixed, what is the best treatment option?
Extensor mechanism allograft
Revision of the patellar component with cement and bone grafting of any residual defect
Open reduction and internal fixation of the patella fracture
Non-operative treatment in a knee brace locked in extension for 6 weeks
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A 62-year-old woman is brought to the emergency room after falling down a flight of stairs. Prior to her fall, she had no knee pain and was a community ambulator without assistance. Intraoperatively, it is determined that the implants are well-fixed. What is the best next treatment step to optimize her quality of life?
Closed reduction and long leg casting at 20 degrees of flexion for 6 weeks, followed by hinged-knee brace for 6 weeks.
Open reduction and internal fixation with a distal femoral locking plate
Open reduction and internal fixation with a condylar buttress plate
Distal femoral replacement arthroplasty
Closed reduction and fixation with an antegrade intramedullary nail
A 65-year-old female sustains a periprosthetic supracondylar femur fracture proximal to a well-fixed implant. She undergoes direct reduction and locked plating with a titanium distal femoral locking plate via an extensile lateral approach. At 9 months post-operatively, weightbearing is at 50% and is painful. Examination reveals mild swelling and warmth around the distal incision. Erythrocyte sedimentation rate and C-reactive protein are normal. Radiographs taken 9 months post-operatively are shown in Figure A. Which of the following may have increased the risk of this complication?
Neglecting to add topical rhBMP-2 on a carrier-scaffold
Neglecting to use lag screws and cerclage cables
Locked plating instead of locked antegrade nailing
Use of a titanium plate instead of a stainless steel plate
Use of an extensile lateral approach instead of a submuscular approach
A 58-year-old woman is seen in the emergency department after falling at home. History reveals that she underwent right total knee arthroplasty 2 years ago. Radiographs are shown in Figures 56a and 56b. What is the most appropriate treatment?
Closed reduction and casting
Bed rest and skeletal traction
Open reduction and internal fixation
Retrograde intramedullary nailing
Revision of the femoral component with a stemmed component
A 75-year-old woman who fell on her right knee now reports pain and is unable to bear weight. History reveals that she underwent total knee arthroplasty on the right knee 6 years ago. Radiographs are shown in Figure 5. Management should now consist of
closed reduction and casting for 6 weeks.
open reduction and internal fixation, using a locked intramedullary rod.
open reduction and internal fixation, using two cancellous screws.
open reduction and internal fixation, using a locked plate and screws.
open reduction and internal fixation and revision of the femoral component.
All of the following are risk factors for post-operative total knee arthroplasty periprosthetic supracondylar femur fractures EXCEPT:
Chronic steroid therapy
Revision knee arthroplasty
A 73 year-old female underwent total knee arthroplasty 10 years ago. She sustained a proximal tibial shaft periprosthetic fracture after a ground level fall. Radiographs show that the fracture involves the tibial component's stem with loosening of the tibial component. Which of the following is the most appropriate treatment?
Open reduction and internal fixation of the tibia
Intramedullary rod fixation
Revision with a long stem tibial component that bypasses the fracture