I slide a nail past the fracture and get them walking without a - PowerPoint PPT Presentation

I slide a nail past the fracture and get them walking without a fatal PE Kristoff Reid, MD

Disclosures • No financial disclosures, however… • Dr. Mears is the first traumatologist I ever worked with – I agree with whatever he says • But – there are a lot of ways to skin a cat

Learning Objectives • Identify periprosthetic distal femur fractures suitable for nail • Understand which total knees can accommodate a nail

Which periprosthetic fractures can be nailed?

Su Classification of periprosthetic distal femur fractures I II III

But don’t forget • You need a space for the nail to go through.

Don’t end up like this! Jones 2016

Why not just plate it? • Plating works well

Reasons to think about a nail • Fracture amenable to early weight bearing • Medial comminution • Soft tissue / patient considerations

But what about PE? • Little data for this particular question • Very similar rates for plate vs nail – White 2003 1.9 vs 1.4 (VTE) • Rate of fatal PE is very low, even in tumor population – Shallop 2015

What are the outcomes? • Generally very similar (malunion) • Some suggestion that operative time and time to union may be improved with nail. Shin 2017

In Summary • Plates are great! • But don’t be scared to use a nail • Just make sure it will fit: – Jones et al: Retrograde femoral nailing of periprosthetic fractures around total knee replacements. Injury, 2016, 460-464