Introduction and importance: Periprosthetic fractures of the femur and tibia after total knee arthroplasty (TKA) can be difficult to treat due to pre-existing conditions and implant-related factors. The reported rate of periprosthetic fractures of tibia and femur after TKA is between 0.3 to 2.5%, in which the tibia is less frequently affected. Case presentation: This case report presents a patient with a distal tibia periprosthetic fracture in the presence of a long-stemmed revision TKA. Surrounding soft tissues were critical due to multiple previous surgeries with existing hardware due to a previous ankle fracture. In this case, the fracture was fixed internally by minimal-invasive dorsal plate osteosynthesis using a posteromedial approach proximally in combination with a posterolateral approach distally. After 6 month the fracture healed without any complications. Clinical discussion: Established methods of fracture fixation for subprosthetic fractures of the distal tibia may be unsuitable in patients with critical soft-tissue conditions. Treatment alternatives like conservative management or frame fixation may be inappropriate and associated with patient discomfort. Posterior minimally invasive plate fixation is a treatment alternative in conditions, where established techniques reach their limits. Conclusion: Minimal invasive dorsal plate osteosynthesis of a distal tibia fracture in the presence of a TKA with long stems is an option to achieve stable bone fracture healing, especially when anterior soft tissues are critical. A combination of two minimally invasive approaches to the tibia enables a safe implant insertion with a low risk of complications.
Lang et al. (Mon,) studied this question.
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