노년의 대퇴골 원위부 골절 시 동시에 시행한 전슬관절 성형술 및 금속판 내고정술 : 8예 보고 Report of Eight Cases = Simultaneous Internal fixation and Total Knee Arthroplasty for Supracondylar Fracture of the Femur in the Elderly Patients with

다국어 초록 (Multilingual Abstract)

Supracondylar fracture of the femur can be treated by a wide variety of methods. Although satisfactory results have been achieved with either open and closed treatment, less certain results are obtained for the elderly who have pre-existing osteoarthritis and osteoporosis. Particularly, elderly patients who have preexisting osteoarthritis are at increased risk of posttraumatic arthritis, stiff knee, persistent pain. Primary total knee arthroplasty(TKA) might obviate many of these potential problems and help to return the high-risk patient to an ambulatory functional status immediately. There are few reports about this study. The purpose of this study is to evaluate the results treated by simultaneous internal fixation and TKA for the supracondylar fracture in the elderly who have osteoarthritis of the knee joint. From 1994 to 1998, eight primary TKAs using posterior cruciate sparing PFC knee(Press Fit Condylar, Johnson & Johnson, Raynham, U.S.A) were performed after internal fixation for the supracondylar fracture of the femur with Judet plate or condylar buttress plate by conventional means. Patella was not resurfaced in all knees. According to the M ller classification of the supracondylar fracture of the femur 5 fractures were type A, 2 in type B, 1 in type C. Five patients were female, 3 patients were male. The ages ranged from 66 to 81, with an average of 74 years. Patients were followed for at least 1 year(average 3 years). The mean interval between the injury and operation was 2 weeks(range, 1 week to 4 weeks). Active knee joint exercise was encouraged in a hinge brace under the postoperative pain control. Partial weight bearing was permitted at the postoperative 4 to 6 weeks using crutches. Full weight bearing was allowed after union of the fracture. Fractures were united in all patients and the average duration of bony union was 16 weeks. The average amount of flexion and average flexion contracture for the all patients at the most recent follow-up were 96 degrees (range, 45 to 120 degrees) and 7 degrees (range, zero to 20 degrees), respectively. Using the knee rating score advocated by the American Knee Society, the average postoperative score was 87 for pain and 80 for function. We concluded that simultaneous internal fixation and TKA for supracondylar fracture of the femur in elderly patients who have advanced knee osteoarthritis may provide satisfactory pain relief and function with acceptable morbidity.