# Different approaches to managing bilateral distal femur periprosthetic fractures in a single patient: case reports and review of the literature

## TL;DR

A 61-year-old woman with bilateral knee replacements experienced fractures requiring different treatments, with better outcomes from intramedullary nail fixation.

## Contribution

The paper presents a case report comparing treatment outcomes for bilateral periprosthetic fractures and advocates for intramedullary nail fixation.

## Key findings

- The patient reported significantly higher pain and lower functionality after distal femur replacement compared to intramedullary nail fixation.
- KOOS scores showed statistical significance between the two treatments, favoring intramedullary nail fixation.
- The findings suggest intramedullary nail fixation is preferable for distal femur periprosthetic fractures despite alignment challenges.

## Abstract

A 61-year-old female with a bilateral total knee arthroplasty (2010) and subsequent separate bilateral distal femur periprosthetic fractures (2020 and 2022) treated with distal femur replacement (left) and retrograde intramedullary nail fixation (right). Self-reported outcomes and knee injury and osteoarthritis outcome scores (KOOS) were compared. The patient reported higher pain and lower functionality with the left knee (overall KOOS of 50%) and no lasting impact or pain with the right knee (overall KOOS of 89%). When KOOS individual (P-value of <0.0001) and categorical/overall (P-value of 0.0048) metrics were compared they demonstrated statistical significance. The report’s data, based solely on a one-sample-size data set, suggest that performing an intramedullary nail for distal femur periprosthetic fractures should be the preferred choice based on this patient’s improved pain, functionality, and overall satisfaction, even if anatomic alignment is difficult.