Twenty fractures of the distal part of the femur proximal to a total
knee replacement were treated operatively by members of the New England
Trauma Study Group. Notching of the anterior aspect of the femoral cortex
was associated with only two of these fractures, and none of the knee
prostheses was loose at the time of the fracture. All twenty fractures were
treated with open reduction and stable internal fixation, and the operation
on fifteen fractures was supplemented with bone grafts. Every fracture
healed, and eighteen healed after a mean of sixteen weeks (range, six to
forty weeks). Union of the other two fractures was delayed, but repeat open
reduction and internal fixation combined with autogenous bone-grafting
resulted in union. After operative treatment, the patients returned to the
level of activity that they had had before the fracture. The pre-existing
tibiofemoral alignment and range of motion of the knee were also restored.
At the time of follow-up, the average clinical rating of the Knee Society
for all twenty knees had not decreased compared with the score before the
fracture.