Abstract Title: ANTEGRADE ENDOSTEAL FIBULAR STRUT AUGMENTATION FOR PERIPROSTHETIC FEMUR FRACTURE ABOVE STEMMED TOTAL KNEE ARTHROPLASTY Abstract ID: 245 Abstract Category: Clinical Research Introduction: The management of peri-prosthetics fracture around total knee replacements is technically challenging. The options for operative fixation become more limited if the femoral component is stemmed, which often is the case after revision arthroplasty procedures. The goals of surgery for peri-prosthetic fractures above knee replacements are to provide a rigid construct to promote healing, allow immediate knee range of motion, and allow weight bearing during the healing process. Purpose: The purpose of this study is to describe the indication and the technical steps for placement of an antegrade, endosteal fibular strut used to augment lateral plate fixation for a peri-prosthetic fracture above a stemmed total knee replacement system. Methods: The surgical indications and steps are exemplified in the case of a 93-year-old female that sustained a pathologic, diaphyseal femoral fracture above a stemmed total knee replacement. The surgical positioning, approach, selection of size and length of the fibular strut, and method of insertion are detailed and illustrated based on the case example. Discussion: The use of an endosteal fibular strut in fracture management is not a novel idea. This type of allograft support has been used in other fracture patterns, most notably the proximal humerus and the distal femur. Biomechanical studies and case series have validated the results of endosteal fibular strut use in these other anatomic areas. The described technique that the authors propose adds to the literature and gives the orthopaedic surgeon another option for the management of fractures above a stemmed total knee replacement. Conclusion: Antegrade, endosteal fibular strut augmentation for fractures above a stemmed total knee replacement is a viable option for surgical management of this complex problem. The use of appropriate indications and sound surgical technique is paramount for the patient to achieve a satisfactory result. The goal of treatment is to provide fixation that allows the extremity to maintain length, alignment, and rotation while allowing the patient to begin range of motion and immediate weight bearing.