Tapish Shukla1, Abhishek Vaish1, Raju Vaishya1, Mohit Kumar Patralekh2. 1. Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi, 110076, India. 2. Chief Medical Officer & Orthopaedic Surgeon, Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India.
Abstract
Background: Periprosthetic tibial fractures in Total Knee Arthroplasty are much less commonly seen than femoral fractures, and there is a paucity of available literature and management recommendation for these fractures. We aimed to identify the relevant and up-to-date literature on this subject to analyse the incidence, risk factors, and management recommendations. Methods: A literature search was done on the databases of PubMed and SCOPUS using appropriate keywords. All the published literature in the English language was included for this review. Results: We included 21 studies comprising 260 tibial periprosthetic fractures (91 intra-operative (35%) and 169 (65%) post-operative or delayed fractures). Only 5.9% of these fractures were managed conservatively. Whereas 98 cases (58%) were managed with open reduction and internal fixation (ORIF) with plating, 19 (11.2%) were managed with revision TKA. Seventeen cases (10%) were managed with minimally invasive percutaneous plate osteosynthesis (MIPPO), and 8 (4.7%) were managed with intramedullary nailing. Less than 6% of cases were managed with other means, viz. megaprosthesis (n = 4), arthrodesis (n = 5), amputation (n = 1), and external fixator (n = 1). Conclusion: Intraoperative fractures accounted for one-third of the fractures in our review. A majority of the delayed periprosthetic fractures were treated with surgical intervention. The most preferred surgical treatment method was ORIF of fractures using locking plates (either open or MIPPO). Revision TKA or megaprosthesis was used in cases with the loosened implants in association with the fracture. Level of evidence: IV.
Background: Periprosthetic tibial fractures in Total Knee Arthroplasty are much less commonly seen than femoral fractures, and there is a paucity of available literature and management recommendation for these fractures. We aimed to identify the relevant and up-to-date literature on this subject to analyse the incidence, risk factors, and management recommendations. Methods: A literature search was done on the databases of PubMed and SCOPUS using appropriate keywords. All the published literature in the English language was included for this review. Results: We included 21 studies comprising 260 tibial periprosthetic fractures (91 intra-operative (35%) and 169 (65%) post-operative or delayed fractures). Only 5.9% of these fractures were managed conservatively. Whereas 98 cases (58%) were managed with open reduction and internal fixation (ORIF) with plating, 19 (11.2%) were managed with revision TKA. Seventeen cases (10%) were managed with minimally invasive percutaneous plate osteosynthesis (MIPPO), and 8 (4.7%) were managed with intramedullary nailing. Less than 6% of cases were managed with other means, viz. megaprosthesis (n = 4), arthrodesis (n = 5), amputation (n = 1), and external fixator (n = 1). Conclusion: Intraoperative fractures accounted for one-third of the fractures in our review. A majority of the delayed periprosthetic fractures were treated with surgical intervention. The most preferred surgical treatment method was ORIF of fractures using locking plates (either open or MIPPO). Revision TKA or megaprosthesis was used in cases with the loosened implants in association with the fracture. Level of evidence: IV.
Authors: Adam A Sassoon; Cody C Wyles; German A Norambuena Morales; Matthew T Houdek; Robert T Trousdale Journal: J Arthroplasty Date: 2014-05-22 Impact factor: 4.757
Authors: Justin M Haller; Erik N Kubiak; Andre Spiguel; Michael J Gardner; Daniel S Horwitz Journal: J Orthop Trauma Date: 2014-12 Impact factor: 2.512