Published online Oct 18, 2017. doi: 10.5312/wjo.v8.i10.809
Peer-review started: February 13, 2017
First decision: June 14, 2017
Revised: August 21, 2017
Accepted: September 3, 2017
Article in press: September 4, 2017
Published online: October 18, 2017
Processing time: 261 Days and 5.7 Hours
We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type III peri-prosthetic femoral fractures in relation to a total knee replacement (TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System (PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up (6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.
Core tip: When dealing with periprosthetic fractures around a total knee replacement it is essential to consider the fracture site and configuration to allow selection of an implant that provides optimal fixation. When managing extremely distal femoral fractures a non-anatomic locking plate, such as Proximal Humeral Internal Locking System, may provide an option for fixation other than the available site-specific plates.