Management of supracondylar fractures proximal to total knee arthroplasty with the GSH supracondylar nail.

The management of a supracondylar fracture above a total knee arthroplasty requires a cautious surgical approach. Currently, the standard method of plate/screw internal fixation of this type of fracture has yielded only fair results. A new technique of retrograde intramedullary nailing through the femoral component using the GSH supracondylar nail is described in this report. A review of four series in which more than 50 patients were treated using the GSH nail indicates a significant difference in bone grafting (10% versus 75%), delayed union (7.2% versus 50%), nonunion (1.9% versus 10%), and surgical revision (0 versus 10%) compared to plate/screw fixation of similar fractures. The findings in this review indicate that the GSH supracondylar nail provides excellent biomechanical stability in these complex fractures, resulting in minimal complications and allowing early return of the patient to functional activities.