Donnelly KJ, Tucker A, Ruiz A, Thompson NW. Managing extremely distal periprosthetic femoral supracondylar fractures of total knee replacements - a new PHILOS-ophy. World J Orthop 2017; 8(10): 809-813 [PMID: 29094012 DOI: 10.5312/wjo.v8.i10.809]
Corresponding Author of This Article
Kevin J Donnelly, Specialist Registrar in Trauma and Orthopaedic Surgery, Department of Trauma and Orthopaedic Surgery, Altnagelvin Hospital, Glenshane Road Derry, Londonderry BT47 6SB, Northern Ireland, United Kingdom. kevin.donnelly@belfasttrust.hscni.net
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Oct 18, 2017; 8(10): 809-813 Published online Oct 18, 2017. doi: 10.5312/wjo.v8.i10.809
Managing extremely distal periprosthetic femoral supracondylar fractures of total knee replacements - a new PHILOS-ophy
Kevin J Donnelly, Adam Tucker, Angel Ruiz, Neville W Thompson
Kevin J Donnelly, Adam Tucker, Angel Ruiz, Neville W Thompson, Department of Trauma and Orthopaedic Surgery, Altnagelvin Hospital, Londonderry BT47 6SB, Northern Ireland, United Kingdom
Author contributions: Donnelly KJ and Tucker A contributed equally to the paper in terms of literature review and writing of the paper; Ruiz A and Thompson NW developed operative technique and performed the surgery; Ruiz A and Thompson NW were also involved in the writing of the paper.
Institutional review board statement: The case report was exempt from the Institutional Review Board standard at Altnagelvin Area Hospital in Londonderry, Northern Ireland.
Informed consent statement: Both patients gave verbal consent for their inclusion in this manuscript and written consent for the operative intervention.
Conflict-of-interest statement: None of the authors have any conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kevin J Donnelly, Specialist Registrar in Trauma and Orthopaedic Surgery, Department of Trauma and Orthopaedic Surgery, Altnagelvin Hospital, Glenshane Road Derry, Londonderry BT47 6SB, Northern Ireland, United Kingdom. kevin.donnelly@belfasttrust.hscni.net
Telephone: +44-28-71345171
Received: January 29, 2017 Peer-review started: February 13, 2017 First decision: June 14, 2017 Revised: August 21, 2017 Accepted: September 3, 2017 Article in press: September 4, 2017 Published online: October 18, 2017
Abstract
We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type III peri-prosthetic femoral fractures in relation to a total knee replacement (TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System (PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up (6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.
Core tip: When dealing with periprosthetic fractures around a total knee replacement it is essential to consider the fracture site and configuration to allow selection of an implant that provides optimal fixation. When managing extremely distal femoral fractures a non-anatomic locking plate, such as Proximal Humeral Internal Locking System, may provide an option for fixation other than the available site-specific plates.
