Periprothetische distale Femurfrakturen stellen uns vor Herausforderungen in Bezug
auf die Versorgungsstrategien. Diese reichen von der Osteosynthese bis zur Revisionsprothese.
Eine breite orthopädisch-unfallchirurgische Ausbildung ist die Basis für die bestmögliche
Versorgung, die präoperative Planung/Analyse (Frakturtyp, Prothesendesign, Bone Stock)
und für den Erfolg entscheidend. Das Ziel sollte die rasche Remobilisation unter Vollbelastung
sein.
Abstract
Periprosthetic distal femur fractures (PDFF) after total knee arthroplasty are increasingly
encountered due to aging populations and comorbidities such as osteoporosis and falls
in the elderly. Conservative management plays only a minor role, while treatment strategies
focus on revision arthroplasty or osteosynthesis. Intramedullary nailing and plate
fixation, including dual-plate constructs, represent the main options, each influenced
by prosthesis type, fracture morphology, and bone stock.
Retrograde nailing provides a minimally invasive option but is limited by implant
design, whereas plating offers greater flexibility and stability, particularly in
complex fracture patterns. Dual plating may enable earlier full weight-bearing and
reduce mechanical complications. Preoperative assessment of prosthesis type, bone
quality, and patient comorbidities is crucial.
Management must be individualized, as no universal algorithm exists. The primary goals
are stable fixation,
early mobilization, and restoration of pre-injury functional capacity to minimize
morbidity and mortality.
Schlüsselwörter
periprothetische Frakturen - Revisionsendoprothese - Knietotalendoprothese - distales
Femur - Dual Plating
Keywords
periprosthetic fractures - revision arthroplasty - total knee arthroplasty (TKA) -
distal femur - dual plating
