Abstract
References
- Meek RMD, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of periprosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br. 2011;93(1):96-101. doi:10.1302/0301-620x.93b1.25087
- Kim KI, Egol KA, Hozack WJ, Parvizi J. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res. 2006;446:167-175. doi:10.1097/01.blo.0000214417.29335.19
- Herrera DA, Kregor PJ, Cole PA, Levy BA, Jönsson A, Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006). Acta Orthop. 2008 Feb;79(1):22-7. doi:10.1080/17453670710014716
- Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28(2):83-89. doi:10.1097/bot.0b013e31829e6dd0
- Rodriguez EK, Boulton C, Weaver MJ, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury. 2014 Mar;45(3):554-9. doi:10.1016/j.injury.2013.10.042
- Zlowodzki M, Bhandari M, Marek DJ, Cole PA, Kregor PJ. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). J Orthop Trauma. 2006;20(5):366-371. doi:10.1097/00005131-200605000-00013
- Appleton P, Moran M, Houshian S, Robinson CM. Distal femoral fractures treated by hinged total knee replacement in elderly patients. J Bone Joint Surg Br. 2006 Aug;88(8):1065-70. doi:10.1302/0301-620X.88B8.17878
- Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res. 2013;99(3):353-360. doi:10.1016/j.otsr.2012.10.014
- Ricci WM, Loftus T, Cox C, Borrelli J. Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above total knee arthroplasty. J Orthop Trauma. 2006 Mar;20(3):190-196. doi:10.1097/00005131-200603000-00005
- Fulkerson E, Tejwani N, Stuchin S, Egol K. Management of periprosthetic femur fractures with a first generation locking plate. Injury. 2007 Aug;38(8):965-72. doi:10.1016/j.injury.2007.02.026
- Erinç S, Cam N, Kanar M, Özdemir HM. Comparison of two surgical techniques for periprosthetic supracondylar femoral fractures: minimally invasive locking plate versus retrograde femoral nails. Med Bull Sisli Etfal Hosp. 2021;16:477. doi:10.14744/SEMB.2021.34270
- Ebraheim NA, Kelley LH, Liu X, Thomas IS, Steiner RB, Liu J. Periprosthetic distal femur fracture after total knee arthroplasty: a systematic review. Orthop Surg. 2015;7(4):297-305. doi:10.1111/os.12199
- Su ET, Kubiak EN, Dewal H, Hiebert R, Di Cesare PE. A proposed classification of supracondylar femur fractures above total knee arthroplasties. J Arthroplasty. 2006;21(3):405-408. doi:10.1016/j.arth.2005.05.022
- Bernstein BP, Rivkin G, Weil YA, et al. How resources affect management of periprosthetic fractures of the distal femur: perspectives from Israel, South Sudan, and South Africa. OTA Int. 2023 Mar 28;6(1 Suppl):e238. doi:10.1097/OI9.0000000000000238
- Dunbar RP, Egol KA, Jones CB, et al. Locked lateral plating versus retrograde nailing for distal femur fractures: a multicenter randomized trial. J Orthop Trauma. 2023 Feb 1;37(2):70-76. doi:10.1097/BOT.0000000000002482
Choosing the Appropriate Fixation Method for Periprosthetic Fractures After Total Knee Arthroplasty: Retrograde Nail or Locking Plate?
Abstract
Objective: This study aimed to compare retrograde intramedullary nailing (RIMN) and femoral locked plating (FLP) in the management of periprosthetic supracondylar femur fractures (PSFF) following total knee arthroplasty (TKA), focusing on fracture healing, blood loss, functional outcomes, and complication rates.
Methods: Thirty-one patients surgically treated for PSFF between 2015 and 2021 were retrospectively analyzed. According to the fixation method, patients were divided into two groups: FLP (n=19) and RIMN (n=12). Group allocation was based on fracture pattern, distal fragment length, and prosthesis compatibility. Fractures were classified according to the Su system. Operative parameters, intraoperative blood loss, transfusion requirement, union time, complications, and functional outcomes (Knee Society Score, KSS) were evaluated. Statistical analysis was performed using SPSS 23.0, with a significance level of p<0.05.
Results: No significant difference was found between groups in terms of demographics, fracture type, or complication rate (p>0.05). The RIMN group showed significantly lower intraoperative blood loss and transfusion requirements (p<0.001 and p=0.016, respectively). KSS and KSS-functional scores were significantly higher in the RIMN group (p=0.022 and p=0.028). There was no significant difference in union time between the two fixation methods.
Conclusion: Both fixation methods are effective for PSFF treatment; however, RIMN provides advantages in terms of reduced blood loss, lower transfusion needs, and superior postoperative functional outcomes. Surgical method selection should be individualized according to bone quality, fracture morphology, and prosthesis compatibility.
Keywords
Periprosthetic supracondylar femur fracture Total knee arthroplasty Retrograde intramedullary nailing Locked plate fixation Orthopedic trauma
Ethical Statement
This study was conducted with the approval of the ethics committee, and all procedures were carried out in accordance with ethical principles.There is no conflict of interest among the authors.All authors contributed equally to this work.
Thanks
We would like to thank the orthopedic doctors at Sakarya Training and Research Hospital for their contributions.
References
- Meek RMD, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of periprosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br. 2011;93(1):96-101. doi:10.1302/0301-620x.93b1.25087
- Kim KI, Egol KA, Hozack WJ, Parvizi J. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res. 2006;446:167-175. doi:10.1097/01.blo.0000214417.29335.19
- Herrera DA, Kregor PJ, Cole PA, Levy BA, Jönsson A, Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006). Acta Orthop. 2008 Feb;79(1):22-7. doi:10.1080/17453670710014716
- Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28(2):83-89. doi:10.1097/bot.0b013e31829e6dd0
- Rodriguez EK, Boulton C, Weaver MJ, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury. 2014 Mar;45(3):554-9. doi:10.1016/j.injury.2013.10.042
- Zlowodzki M, Bhandari M, Marek DJ, Cole PA, Kregor PJ. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). J Orthop Trauma. 2006;20(5):366-371. doi:10.1097/00005131-200605000-00013
- Appleton P, Moran M, Houshian S, Robinson CM. Distal femoral fractures treated by hinged total knee replacement in elderly patients. J Bone Joint Surg Br. 2006 Aug;88(8):1065-70. doi:10.1302/0301-620X.88B8.17878
- Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res. 2013;99(3):353-360. doi:10.1016/j.otsr.2012.10.014
- Ricci WM, Loftus T, Cox C, Borrelli J. Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above total knee arthroplasty. J Orthop Trauma. 2006 Mar;20(3):190-196. doi:10.1097/00005131-200603000-00005
- Fulkerson E, Tejwani N, Stuchin S, Egol K. Management of periprosthetic femur fractures with a first generation locking plate. Injury. 2007 Aug;38(8):965-72. doi:10.1016/j.injury.2007.02.026
- Erinç S, Cam N, Kanar M, Özdemir HM. Comparison of two surgical techniques for periprosthetic supracondylar femoral fractures: minimally invasive locking plate versus retrograde femoral nails. Med Bull Sisli Etfal Hosp. 2021;16:477. doi:10.14744/SEMB.2021.34270
- Ebraheim NA, Kelley LH, Liu X, Thomas IS, Steiner RB, Liu J. Periprosthetic distal femur fracture after total knee arthroplasty: a systematic review. Orthop Surg. 2015;7(4):297-305. doi:10.1111/os.12199
- Su ET, Kubiak EN, Dewal H, Hiebert R, Di Cesare PE. A proposed classification of supracondylar femur fractures above total knee arthroplasties. J Arthroplasty. 2006;21(3):405-408. doi:10.1016/j.arth.2005.05.022
- Bernstein BP, Rivkin G, Weil YA, et al. How resources affect management of periprosthetic fractures of the distal femur: perspectives from Israel, South Sudan, and South Africa. OTA Int. 2023 Mar 28;6(1 Suppl):e238. doi:10.1097/OI9.0000000000000238
- Dunbar RP, Egol KA, Jones CB, et al. Locked lateral plating versus retrograde nailing for distal femur fractures: a multicenter randomized trial. J Orthop Trauma. 2023 Feb 1;37(2):70-76. doi:10.1097/BOT.0000000000002482
Details
| Primary Language | English |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Research Article |
| Authors | |
| Submission Date | August 26, 2025 |
| Acceptance Date | November 19, 2025 |
| Early Pub Date | February 4, 2026 |
| Publication Date | February 4, 2026 |
| DOI | https://doi.org/10.31832/smj.1771451 |
| IZ | https://izlik.org/JA95RK24WC |
| Published in Issue | Year 2026 Issue: Advanced Online Publication |
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Sakarya Medical Journal aims to develop medical science and its members with an open, free, and accessible publishing approach. It presents original and current medical articles to its readers.
Sakarya Medical Journal is a scientific journal that aims to reach all national and international medical institutions and personnel, publishing retrospective, prospective, or experimental research, reviews, case reports, editorial comments/discussion, letters to the editor, and current issues that determine the medical agenda that may be related to every branch of medicine. The journal is published four times a year in March, June, September, and December.
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• The article should not be sent to different journals at the same time and should not have been sent to another journal before. If it is found to have been sent to another journal, the publication process will be canceled.
• It is assumed that the authors who submit articles to the journal have read and accepted the publication and writing principles of the journal, and the authors are deemed to have committed to these principles.
• The citations and bibliography should be complete.
• Plagiarism and fake data should be avoided.
• The similarity rate obtained as a result of the similarity checks should not exceed 30% in order to initiate the peer review process.
• An article may be included in a maximum of 2 PRE-REVIEW processes. The article will be rejected if the feedback conveyed to the author is not revised.
• The corresponding author must inform the journal editor in case of any conflict of interest.
This issue can be referred to WAME.
Ethical Guidelines for Peer Reviewers
• Peer reviewers should be aware that they play a critical role in the academic quality of the article to be published in the journal, and they should engage in the peer review process with the responsibility of improving academic quality.
• Peer reviewers should only accept to review articles for which they have the expertise to make an appropriate assessment. They should also respect the confidentiality of the blind peer review process and keep the details of the article confidential at all costs.
• After the review process, any information about the reviewed article should not be shared with others under any circumstances.
• Peer reviewers should only evaluate the accuracy of the content of the articles and their compliance with academic criteria. Any difference of opinions between the article's argument and the peer reviewer should not affect the review process.
• Peer review reports should be objective and measurable. Libelous, derogatory, or accusatory expressions should definitely be avoided.
• Peer reviewers should avoid superficial or inaccurate statements in their peer review reports. In reviews with negative results, a complete justification should be presented on the aspects that led to the negative result.
• Peer reviewers should review the articles within the time period allotted to them. If they are not going to review the article, they should notify the journal within a reasonable time.
• Peer reviewers should identify relevant published work that has not been cited by the authors. Any statement that an observation, derivation, or argument had been previously reported should be accompanied by the relevant citation. A reviewer should also call to the editor's attention any substantial similarity or overlap between the manuscript under consideration and any other published paper of which they have personal knowledge.
Ethical Guidelines for Editors
• Editors should accept articles that will contribute to the relevant areas specified in the journal policy.
• Editors should not have any conflict of interest with accepted or rejected articles.
• Editors have full responsibility and authority to accept or reject an article.
• It is editors' responsibility to keep the names of peer reviewers and authors mutually confidential.
• Only the articles that will contribute to the relevant field should be accepted.
• If an error is detected, editors should support the correction or retraction of the error.
• It is the duty of editors to complete the pre-review, peer review, editing and publishing processes of the articles submitted to the journal in a timely and appropriate manner.
• Editors should not assign people who do not contribute to the journal as editorial board members or associate editors.
2. Publication Policy
Any manuscript that is considered to be published in Sakarya Medical Journal must meet the following criteria:
• Originality
• Not containing ethical violations
• Having clear messages for the scientific community
• Expressing the extent of the article's contributions to researchers in the field and its relevance to social sciences
• Current fields and topics drawing the interest of researchers in the field of health sciences
• Having structural and logical integrity
• Research results that are based on scientific evidence
• Coherence of the scientific method
Review of the Articles
Articles can be submitted to the Sakarya Medical Journal by registering in the "Article Management System" on https://dergipark.org.tr/en/journal/630/submission/step/manuscript/new
Articles sent by e-mail will not be taken into consideration.
Pre-Review and Plagiarism Checking
The journal's compliance with the writing rules is examined and a similarity check is made to prevent plagiarism. Similarity software is used in the checking process. The overall similarity rate should be less than 30%. If the similarity rate is more than 30%, the study is either rejected or sent back to the author to reduce the similarity rate. The pre-review is completed within a maximum of 30 days.
Editor/Field Editor Review
After the study passes the stages of pre-review and similarity checking, it is reviewed by the relevant editor/field editor in terms of subject, scope, language use, and academic competence. This review is completed within a maximum of 30 days.
Peer Review Process (Double-Blind Peer Review)
Studies that pass the pre-review and editorial review undergo a confidential double-blind peer review process. Within the double-blind strategy, the identity of the peer reviewer is concealed from the author submitting publications to the journal. Similarly, the peer reviewers do not know who wrote the article they are reviewing. In other words, the peer review process is conducted by keeping both authors and peer reviewers anonymous to each other. The reports are also stored in the Article Management System.
Author's Revision
Authors take into account the feedback, criticisms, and recommendations of the reviewer and the Editorial Board. In case of any disagreement, they have the right to appeal with their justifications. Authors edit the article as per the reports and upload the final version of the article to the system.
Field Editor Review
The field editor checks whether the author has made the requested corrections in the text. If there is a “Major Revision” requirement in the peer review reports, they send the article to the relevant peer reviewer. If there is an "Acceptance" or "Minor Revision" requirement and the revisions are completed, they can submit the article for language checks (The checking process is completed within a maximum of 7 days.). If they detect that the corrections have not been made, they re-send the article to the author. They may reject the article if the author does not make the corrections again. Articles that are not accepted for publication are not deleted from the system. Their processes and files are stored in the system.
English Language Checks
The checking process is completed within 15 days at the latest.
Editorial Board Review
The articles that pass technical, academic, and linguistic reviews are examined by the Editorial Board, and the final publication status is determined. In case of any objection from the members, the Board decides by a majority of votes.
Typesetting and Layout Process
The journal undertakes the typesetting and layout processes of the studies decided to be published by the Editorial Board.
Language
Sakarya Medical Journal publishes articles written in English.
Change of Authorship
Sakarya Medical Journal accepts article authors according to the statement on the Title Page of the article. Therefore, it is the responsibility of the authors to submit the final version of the full author list. Requests for any change of authorship after the submission of the article (e.g removal/addition of authors, change of order, etc.) are subject to editorial approval. The Editorial Board will investigate such cases and act according to the COPE flowcharts.
Requests for a change of authorship should be conveyed to the Editor with an official letter stating the reasons for the change. The letter should be signed by all the authors and include their confirmation of the change of authorship. If the request is approved by the Editorial Board, the authors are required to submit a new Copyright Agreement Form according to the final author list.
Disclaimer
The opinions expressed in the articles published in the journal are those of the author(s). They do not purport to reflect the opinions or views of the Sakarya Medical Journal and its Editor-In-Chief, Editorial Board or Publisher. The Editor-in-Chief, Editorial Board, and Publisher assume no responsibility or liability for such cases. The sole responsibility for the published content lies with the authors.
Complaints and Appeals
Sakarya Medical Journal handles complaints and appeals by following the below procedure. Complaints, including but not limited to the long delays in handling studies and publication ethics, are initially handled by the Editor-in-Chief of Sakarya Medical Journal. The Editor-in-Chief examines complaints and appeals together with Area Editors and Editorial Board if applicable. If anything occurs about complaints and appeals please contact sakaryatipdergisi@sakarya.edu.tr.
Complaints about the Content of a Paper
The Editor-in-Chief examines the complaints of the author(s) and the reports of reviewers and make a decision about:
• A fresh opinion from an independent reviewer is needed.
Complaints about Processes
The complaints about processes are handled by the Editor-in-Chief. Long delays in handling studies are examined by editors of Sakarya Medical Journal, and any necessary issues are shared with the Editor-in-Chief. The Editor-in-Chief evaluates the complaints, and when necessary, information is shared with the authors.
Complaints about Ethics
The Editor-in-Chief considers complaints about publication ethics of the author’s or reviewer’s conduct. The editor-in-chief follows the publication ethics on the Sakarya Medical Journal website. The editorial board of Sakarya Medical Journal examines the concerns of complainants or reviewers. The details and progress of the examination are clearly shared with the complainant(s). The Editor-in-Chief or Assistant Editors provide feedback to the complainant(s) on the manner of action and the final decision.
Price Policy
• Sakarya Medical Journal does not request any fees for article submission, reviewing and editing processes, page layout, and publication (page or color fees).
• Sakarya Medical Journal does not pay any fees to authors, reviewers, editors, and editorial board members.
• All papers in Sakarya Medical Journal are free to read and download.
• Sakarya Medical Journal signed on to the Budapest Open Access Initiative (BOAI), which promotes free access to research literature and has adopted the Open Access Principles that are clarified in this initiative.
• All papers in Sakarya Medical Journal are archived with the LOCKSS (Lots Of Copies Keep Stuff Safe) system through TUBITAK ULAKBİM DergiPark.
• Sakarya Medical Journal does not accept announcements, advertisements, sponsorships, etc. due to its publication policy.
• All expenses of Sakarya Medical Journal are covered by Sakarya University.
Indexes
Citation Indexes
Other Indexes
Journal Boards
Baş Editör
Editör Kurulu
Mizanpaj Editörü
Yazım ve Dil Editörü
Ingilizce Dil Editörü
Biyoistatistik Editörü
INDEXING & ABSTRACTING & ARCHIVING
The published articles in SMJ are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.