Buenos días, considero que esta pregunta es impugnable dado que existen protesis de rodilla postero-estabilizadas compatibles con clavos retrógrados para la estabilización de fracturas periprotésicas, tal y como se describe en el siguiente artículo: Thompson SM, Lindisfarne EAO, Bradley N, Solan M. Periprosthetic supracondylar femoral fractures above a total knee replacement: compatibility guide for fixation with a retrograde intramedullary nail. J Arthroplasty [Internet]. 2014;29(8):1639–41. Disponible en:
http://dx.doi.org/10.1016/j.arth.2013.07.027. Por lo tanto, dado que no se describe el tipo exacto de prótesis, tanto la opción 2 (placa condílea de fémur bloqueada de fijación angular) y la opción 3 (Clavo de fémur retrógrado acerrojado largo) serían opciones posibles para el tratamiento de la fractura que padece la mujer del caso clínico.
Adjunto bibliografía en la que se comparan los resultados funcionales y tasas de consolidación en fracturas periprotésicas bajas de fémur distal entre el uso del clavo retrógrado y placa condilea. Considerando los resultados de los estudios en los consideran que no existen diferencias significativas entre ambos métodos de fijación ambas opciones son igual de correctas.
Virkus W, Lieder C, Jang Y, Rea P, Gaski G. Results of low distal femur periprosthetic fractures. J Orthop Trauma [Internet]. 2022;36(8):e300–5. Disponible en:
http://dx.doi.org/10.1097/BOT.0000000000002352. Conclusions: This is the largest series, to the best of our knowledge, of a subset of very distal PDFFs. The results suggest that RIMN may be an acceptable treatment option for these very difficult fractures.
Quinzi DA, Ramirez G, Kaplan NB, Myers TG, Thirukumaran CP, Ricciardi BF. Early complications and reoperation rates are similar amongst open reduction internal fixation, intramedullary nail, and distal femoral replacement for periprosthetic distal femur fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg [Internet]. 2021;141(6):997–1006. Disponible en:
http://dx.doi.org/10.1007/s00402-021-03866-4 Conclusions: There was no difference in major complications or reoperations between the three treatment groups. Deep infection rates were higher in DFR relative to internal fixation, malunion rates were higher in IMN versus ORIF, and periprosthetic fracture rates were higher in DFR and IMN versus ORIF.
Magill H, Ponugoti N, Selim A, Platt J. Locked compression plating versus retrograde intramedullary nailing in the treatment of periprosthetic supracondylar knee fractures: a systematic review and meta-analysis. J Orthop Surg Res [Internet]. 2021;16(1):78. Disponible en:
http://dx.doi.org/10.1186/s13018-021-02222-x. Conclusion: Ten studies with a total of 531 periprosthetic fractures were included. This meta-analysis has suggested that there is no significant difference in any of the outcome measures assessed. Further, more extensive literature is required on the subject to draw more robust conclusions.
