Background: Non union of supracondylar fractures of the femur
in old age patients is difficult to treat because of limited bone
stock for fixation and marked osteoporosis of the distal fragments
and if nonunion occur in osteoarthritic knee treatment will be
more difficult and all methods of treatment associated with many
complications.
Patients and methods: Using cemented rotating-hinge total knee
replacement. The cemented, long-stemmed Endo-model rotatinghinge TKR (Waldemar Link GMBH & Co, Hamburg, Germany),
thirteen total knee replacement were done between 2002 and
2007 for 12 nonunited supracondylar fractures and one nonunited
supracondylar osteotomy, The time interval between the fracture
and performance of TKR ranged from 24 to 62 month, the mean
age of the patients was 69 years (59 to 85). The mean follow up of
50 months (35 to 92 months). Clinical rating system of the
Hospital for Special Surgery and the clinical and radiological
scoring systems of the Knee Society. For patellofemoral status we
used the Outerbridge grading system and we used the scale of
Stern and Insall to assess anterior knee pain.
Results According to the clinical rating system of the Hospital for
Special Surgery excellent results in two patients, good in six
patients, fair in four patients and poor results in one patient, In
nine patients, the knee flexion ranged from 70° to 110, three
patients ranged from 30° to 60° in one patient, the knee flexion
was only 20° .
Conclusion The Endo-model rotating hinge knee replacement is a
good option for those elderly arthritic patients with fractures of
the supracondylar femur that fail to unite with early weight
bearing and expected good and excellent results for most of the
patients |
