PP 130. Patella Maltracking Post Intramedullary Nailing of Supracondylar Fracture

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Z. Jessop, M. Welck, A Mcgrath, N. Goddard

17:24 - 17:30h at Lanchid Room

Categories: Orthopaedic Surgery and Traumatology, Poster Session

Session: Poster II (P4) - Varia

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Background
The incidence of periprosthetic fractures following total knee replacement (TKR) is 5.5% withsupracondylar femur fractures being the most common type. Fixation of supracondylar fractures  following total knee replacements present a challenging problem for orthopaedic surgeons and recognized complications include infection, fixation failure, nonunion and revision surgery. Ourcase highlights a previously unreported potential late complication following intramedullary nailing of a supracondylar periprosthetic fracture.

Material and Methods
A fifty-year-old male patient, who had a good functional outcome and was pain free following hisleft cemented TKR in 1980, sustained a left femoral extra-articular supracondylar periprosthetic comminuted fracture following a fall in 2007 and subsequently underwent internal fixation using a retrograde locked supracondylar femoral nail. He presented five year later with gradual onset of anterior knee pain.

Result
Single-photon emission computed tomography revealed intense tracer uptake in the patellofemoral junction and proximal tibiofibular articulation both of which appeared degenerative with a significant patellofemoral joint space loss with no metabolic features of infection or loosening. It was thought that patellofemoral joint degeneration and hence gradual onset of anterior knee pain was related to patella maltracking due to disruption of joint axis following intramedullary nailing ofthe left supracondylar periprosthetic fracture, supported by the fact that the patient's symptoms  resolved following elective patella resurfacing.

Conclusion
The study population sizes on patients treated with intramedullary nailing for periprosthetic supracondylar fractures are small and lack long term follow up which may explain why this late complication has not previously been reported.