An 80-year-old woman falls 6 years after total knee replacement. Radiographs show a displaced supracondylar femoral fracture. The femoral component is confirmed to be well fixed and stable. Which classification applies and what is the correct treatment?

• A Lewis and Rorabeck type I, non-operative treatment
• B Lewis and Rorabeck type III, revision arthroplasty with a distal femoral replacement
• C Lewis and Rorabeck type II, open reduction and internal fixation ✓
• D Felix type 2, closed reduction and casting

Explanation

The Lewis and Rorabeck classification grades periprosthetic distal femur fractures around a total knee replacement: type I is undisplaced with a fixed implant, type II is displaced with a fixed implant, and type III has either displacement or a loose or failed implant. A displaced fracture around a well-fixed component is type II and needs operative stabilisation, usually with locked plating. Option B fails because the implant is secure, removing the indication for revision.

Reference: Miller's Review of Orthopaedics, 8th ed.

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