High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties.

Fixation of the distal portion of the femur in patients with total knee arthroplasties can be challenging. Locking plates have emerged as a promising treatment. Twenty-seven patients with periprosthetic distal femur fractures after total knee arthroplasties were treated using a contralateral reverse distal femoral locking plate. The average time for union and weight-bearing was 4.5 ± 2.7 months. The union rate was 89%. Thirty-seven percent experienced complications, with 2 delayed unions (7.4%), 1 nonunion (3.7%), and 7 fixation failures (26%). Alteration in blood supply and biomechanics as well as poor existing bone quality and minimal distal femur bone stock may contribute to treatment difficulties. Published by Elsevier Inc.