Periprosthetic knee fractures

Tibial Fractures Morten Schultz Larsen

Odense University Hospital

Incidence

Not as common as distal femur Distal femur: up to 2,5% primary (38% revision)

Tibia : up to 0,4 % primary (more after revision)

Intraoperative 19% (one study)

Classification –tibia

Felix et al. Clin Orthop Relat Res. 1997 Dec;(345):113-24.

102 tibial fractures with TKR

Type I: 60% Tibia plateau fracture

Type II: 21% Fracture around prosthesis

Type III: 17% Fracture distal of prosthesis

Suffix A: Stable prosthesis

B: Loose prosthesis

C: Intraoperative fracture

Classification –tibia

Felix et al. Clin Orthop Relat Res. 1997 Dec;(345):113-24.

102 tibial fractures with TKR Type I: 60% Tibia plateau fracture

Type II: 21% Fracture around prosthesis

Type III: 17% Fracture distal of prosthesis

Type IV: 2% Tuberositas tibia fracture

Suffix A: Stable prosthesis

B: Loose prosthesis

C: Intraoperative fracture

Type 1

1 A Fixation or non-operative (immobilisation and restriction on weight bearing)

1 B Revision

Type 2 2 A

Fixation most often Proximal fixation is very challenging but important

Locking plate (maybe two)

Soft tissues !!!!!!!

2 B Revision

Some 2 A need revision and some 2 B can be fixed

Type 2 A/B?

Fixation or revision ?

Type 2 A

Fixation or revision ?

Basic principles also apply to peri-prosthetic fracture

Type 2

Fixation or revision ?

Basic principles also apply to peri-prosthetic fracture

Stability, bridging, restoring length, axis and rotation

Type 2 B

Fixation or revision ?

Basic principles also apply to peri-prosthetic fracture

Stability, bridging, restoring length, axis and rotation

Healing

Type 3 3 A

Fixation

Type 3 3 A

Fixation Same as 2 A

3 B Should not occur, unless loose before

Type 4 Individual treatment

Extensor mechanism must be restored

Screws and/or plates

Wires

Semitendinosus or allograft

Revision if loose

Type 4 B

Fracture of tuberosity – loose implant

Type 4 B

Fracture of tuberosity

Cemented revision and fixation with parts of a calcaneal plate

Type 4 B

Fracture of tuberosity

Cemented revision and fixation with parts of a calcaneal plate

Seems to heal after 3 months

Summary

Treatment of periprosthetic fractures in tibia is a surgical challenge

The locking plate is the working horse, when fixing the fracture, but the “toolbox” must be extensive

If the prosthesis is loose, a revision is usually, but not always, the best treatment

We find it beneficial to collaborate with arthroplasty surgeons in these cases

Thank you