人工膝関節置換術後の大腿骨骨折の治療

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  • Treatment of Femoral Fracture after Total Knee Replacement.

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We encountered five fractures after total knee replacement. Four were supracondylar fractures and one was a femoral shaft fracture. Of the supracondylar fractures, one occurred after removal of Ender nails, and one was the result of supracondylar cortical notching. The femoral shaft fracture was caused by improper selection of long-stemmed prosthesis after THA. Repeated surgical procedures around the knee, excess incisions of the femoral cortex during surgery, and improper prosthesis selection can cause femoral shaft fractures.<BR>Three of the supracondylar fractures were treated conservatively using skeletal traction followed by functional bracing. As a result, good bone union was obtained and ranges of motion (ROM) were similar to those before surgery. One fracture was treated surgically using K-U screws, but good reduction was not achieved because of the prosthesis. The shaft fracture was treated conservatively using cast immobilization, however, a refracture occurred and surgical therapy was performed. We have found that supracondylar fractures could be adequately treated using a conservative approach combining skeletal traction and functional bracing.

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