Rorabeck and Taylor developed an algorithm for treating a patient with a femoral supracondylar periprosthetic fracture proximal to a knee arthroplasty. The authors are from the University of Western Ontario in Canada.
Parameters:
(1) fracture type (classification of Lewis and Rorabeck, previous section)
(2) bone quality
Fracture Type
Bone Quality
Preferred Therapy
Secondary Therapy
Type I (stable and undisplaced)
NA
closed treatment with brace
ORIF with IM rod, plate/screws, external fixation
Type II (stable and displaced)
NA
ORIF with IM rod, plate/screws, external fixation
closed reduction with brace
Type III (unstable and undisplaced)
good
stemmed revision with ORIF
NA
Type III (unstable and undisplaced)
poor
stemmed revision with or without ORIF, plus bone graft
closed reduction with brace
Type III (unstable and displaced)
good
stemmed revision with or without ORIF, plus bone graft
NA
Type III (unstable and displaced)
poor
stemmed revision OR allograft composite OR custom TKA
NA
where:
• ORIF = open reduction with internal fixation
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