NONSURGICAL MANAGEMENT OF SUPRACONDYLAR FRACTURE ABOVE TOTAL KNEE ARTHROPLASTY - STILL THE 90S OPTION

Supracondylar fracture of the femur above a total knee arthroplasty ha s been reported to occur in 0.3-2.5% of all cases. The case of a patie nt who sustained such a fracture subsequent to a fall and whose fractu re was managed without surgery with a good result is reported. There w as no evidence of coexisting loosening, osteolysis, or significant wea r, and satisfactory bony reduction was achieved, maintaining correct a lignment of the prosthetic components. Healing occurred in 3 months, a nd the patient remains under follow-up evaluation with a painless knee and a range of movement similar to prefracture levels with no evidenc e of implant loosening. Despite the current enthusiasm for internal fi xation of these fractures, a review of the current literature revealed that neither conservative nor operative management has a significant proven advantage, and the treatment of these difficult and uncommon fr actures remains challenging. Nonoperative treatment of fractures above well-fixed components can, however, be as successful as surgical inte rvention, and remains a viable first-line approach. Conservative manag ement also lacks the potential risks of operation, while maintaining t he option of later surgical intervention if required.