Rush rod fixation of supracondylar fractures above total knee arthroplasties

The authors report on 22 displaced supracondylar femur fractures and total knee arthroplasties treated with Rush rod (Berivon, Meridian, MI) fixation. The average age at the time of total knee arthroplasty was 67 years. Fractures occurred at an average of 5 years after surgery. In only five cases was notch in the anterior cortex noted. The follow-up period averaged 7 years. There were no nonunions. All knees healed between 3 and 4 months after surgery. Postoperative flexion averaged 108 degrees (preoperative average, 102 degrees). Only two knees demonstrated a flexion contracture before surgery (5 degrees-10 degrees), and both had flexion contractures after surgery as well (each 10 degrees). All other knees achieved full extension. The average alignment prior to fracture was 7 degrees of anatomic valgus. At the most recent follow-up evaluation this averaged 10 degrees with two knees in 15 degrees of valgus. The only complications noted were two intraoperative technical errors. No postoperative complications occurred. For supracondylar fractures above a total knee arthroplasty, the authors suggest closed reduction, Rush supracondylar rod fixation, early range of motion, and protected weight bearing until fracture healing. In all cases, an extensive surgical procedure was not required.