Setting Yourself Up for Success: Retrograde Intramedullary Nailing in Periprosthetic Fractures About Total Knee Arthroplasty.

Treatment of periprosthetic fractures above total knee arthroplasty remains challenging because of assessment of implant stability and the short segment of often osteoporotic bone available for distal fixation. Fractures with significant medial comminution should undergo retrograde intramedullary nailing or dual-implant fixation, as isolated lateral locked plating is not indicated. There are a multitude of objective and subjective factors incorporated into the decision to proceed with retrograde nailing including assessment of the patient's functional status, fracture morphology, implant stability, and compatibility of the prosthesis with retrograde nailing. Here, we review the steps to success in using retrograde intramedullary nailing in the treatment of specific periprosthetic fractures about total knee arthroplasty.