| Abstract [eng] |
This work describes a case of periprosthetic distal Femur fracture, which was predetermined by earlier knee arthroplasty. In the background of an infectious complication and extensive corticosteroid therapy, the patient was subjected to several treatment methods, in order to achieve bone union: open reduction and internal fixation with a locking plate, implantation of custom cement and metal structures and distal femoral replacement. Demographic changes are leading to a ever-increasing number of older patients with arthrosis, while the improving availability of health care services makes the knee replacement surgery more frequent. As a result, the incidence of complications also increases, one of which is periprosthetic fractures. Periprosthetic fractures are a rare postoperative complication, polymorbid elderly population is exposed to the greatest risk. Diagnostics of this complication is mainly based on patient-history and X-ray imaging. This work discusses the classification systems of periprosthetic distal femoral fractures, their applicability, evolution, advantages and disadvantages. The main risk factors are subdivided into three groups: patient-related, surgery-related and implant-related. Treatment options for periprosthetic fracture are abundand, depending on the fracture type, patient-related factors. Both conservative and operative treatment can be considered. Conservative alternative is the most suitable for a fracture with no dislocation, or for a patient unsuitable for surgical management. The main surgical options are as follows: open reduction and internal fixation with a locking-plate, internal fixation with a retrograde intramedullary nail and revision-surgery. |
