1. Considerations with osteoporosis, preexisting arthritis, and significant articular injury
In elderly patients with osteoarthritis of the knee, it may be inappropriate to attempt fracture fixation. This is a rare situation. It may be better to consider primary joint replacement with the assistance of a specialist knee arthroplasty surgeon. However, it must be recognized that, because of the supracondylar component of the fracture, the result of such a total knee arthroplasty would be significantly worse than an elective primary knee arthroplasty. It may be necessary to use a complex knee prosthesis, such as those with rotating hinges. In very difficult such distal femoral fractures, mega-prosthesis may be required.