Objective:To investigate the treatment methods and efficacy of periprosthetic femoral fractures after total knee ar-throplasty.Methods:A total of 21 patients with periprosthetic femoral fractures (Insall I or II)after total knee arthroplasty from 2007 Jul to 2012 Jun were enrolled.There were 18 patients were followed for 12-26 monthes,with an average time of 19.8 months.Among them,5 cases (Insall I 1,ⅡA 2,ⅡB 2)were treated conservatively,while the other 13 cases (Insall I 1,ⅡA 2,ⅡB 10)were treated with open reduction and internal fixation with a locking-plate.At 6 monthes after fracture,the range of motion,physical line of force were measured,and the knee function of all patients were assessed by hospital for special surgery knee score (HSS).Results:The average HSS score was 75.6 in 5 patients treated conservatively,and 85.08 in 13 patients un-dergone operation.Conclusions:Open reduction and fixation inside with locking-plate is curative for periprosthetic femoral frac-tures after total knee arthroplasty.

Objective :To compare the clinical efficay between dynamic hip screw (DHS)and proximal femoral nail(Intertan) fixation after closed reduction for the treatment of elderly patients with Evans type Ⅰ intertrochanteric fracture .Methods :Among 70 elderly patients with intertrochanteric fracture (Evans Ⅰ ) undergoing surgical treatment ,30 cases (DHS Group) were treated by closed reduction and DHS internal fixation and the other 40 cases (Intertan Group) were treated by closed reduction and Intertan fixation .Results :All the patients were followed up for 6-24 (12 .0 ± 3 .0) months .All the fractures were healed and no complication such as failure of internal fixation or femoral head necrosis occurred . There was statistically significant difference between operation time the DHS group and the Intertan group with 40-90 (63 .6 ± 8 .4) min and 40-90 (55 .6 ± 9 .8) min in DHS Group and Intertan Group ,respectively .And the intraoperative blood loss were 100-200 (145 .4 ± 22 .5) mL and 100-200 (92 .4 ± 25 .5) mL in DHS Group and Intertan Group ,respectively .Furthermore ,the duration of stay were 6-16 (11 .2 ± 2 .8) days and 6-9 (7 .9 ± 1 .1) days in DHS Group and Intertan Group ,respectively .There were significant difference regarding operation time ,intraoperative blood loss ,and duration of stay between the two groups(P< 0 .05) .Wound healing were achieved by postoperative liquefaction wound care in 4 cases of DHS group .There was no significant difference regarding fracture healing time between the 2 .5-4 .0 (3 .4 ± 0 .8) months in DHS Group and the 2 .5-4 .0 (3 .2 ± 0 .7) months in Intertan Group(P> 0 .05) .There were statistically significant differences between the two groups regarding Harris function scores after operation ,which were 67-84 (73 .5 ± 5 .1) points in DHS Group and 70-86 (77 .9 ± 3 .7) points in Intertan Group , and function scores which were 23-40 (30 .8 ± 3 .2) points in DHS Group and 25-44 (34 .4 ± 2 .9) points in Intertan Group (P<0 .05) .There was no significant difference between two groups regarding pain scores ,which were 20-44 (34 .9 ± 4 .8) points in DHS Group and 20-44 (35 .8 ± 5 .0) points in Intertan Group ,and activity range scores ,which were 2-4 (3 .0 ± 0 .8) points in DHS Group and 2-4 (3 .0 ± 1 .0) points in Intertan Group (P> 0 .05) .Conclusions :The Intertan and DHS internal fixation are effective methods for the treatment of elderly patients with intertrochanteric fractures .Intertan showed less trauma ,shorter duration of stay ,and better recovery of hip function .