Knee arthroplasty for acute fractures around the knee

EFORT Open Reviews

article

Thomas Tampere¹  Matthieu Ollivier²  Christophe Jacquet³  Maxime Fabre-Aubrespy³  Sébastien Parratte³ 

[1] Department of Orthopaedic Surgery, Ghent University Hospital;Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital;Department of Orthopaedic Surgery, International Knee and Joint Centre

关键词: elderly;    fracture;    knee;    osteoporosis;    total knee arthroplasty;   

DOI  :  10.1302/2058-5241.5.190059

学科分类：神经科学

来源: The British Editorial Society of Bone & Joint Surgery

【 摘 要 】

the high incidence of femoral neck and proximal humerus fractures, epiphyseal knee fractures account only for up to 1% of annual emergency admissions. Furthermore, the sub-type of fracture appears to be gender related, with a male predominance for proximal tibia fractures (overall incidence 13.3/100,000 adults) whereas distal femoral fractures are more frequently seen in women (overall incidence 4.5/100,000 adults).1–3 Treatment of complex epiphyseal fractures is multifaceted and challenging. Today, especially in young patients, the first choice of treatment remains open reduction and internal fixation. Management of these fractures in the osteoporotic elderly is more demanding as metaphyseal bone loss often limits options for anatomical reconstruction and fixation. Current surgical treatment options, including intramedullary nailing, internal and external fixation, are often complicated by an extended non-weight-bearing period, malunion or nonunion.2,3 Due to the presence of multiple risk factors such as old age, concomitant diseases and osteoporosis, in combination with severe comminution and initial displacement, loss of reduction is described in up to 30–79% of cases, implying loss of function and sometimes a need for subsequent surgery (Fig. 1). To avoid these complications and to shorten the recovery phase, primary total knee arthroplasty (TKA) has been proposed as a first intention solution based on the model of primary hip or elbow arthroplasties for fracture. It is often used as a last resort in the treatment of failed fixation of complex knee fractures.4,5 The main advantages of primary arthroplasty are the ability to preserve joint function and to allow patients to resume full weight-bearing immediately, while prolonged weightbearing restriction is often implemented after internal fixation. Due to cognitive and/or physical impairment, older.

【 授权许可】

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