Dual locking plate fixation for periprosthetic tibial fractures With a well-fixed tibial component after total knee arthroplasty: a retrospective case series

Purpose Periprosthetic tibial fractures (PTFs) after total knee arthroplasty are uncommon and technically demanding injuries, and available evidence is largely derived from heterogeneous retrospective studies. This study aimed to describe the surgical strategy and clinical and radiographic outcomes of dual locking-plate fixation for selected Felix type 2A and 3A fractures with a well-fixed tibial component. Methods This retrospective case series included 13 patients treated between June 2022 and December 2024. Seven fractures were classified as Felix type 2A and six as type 3A. The primary outcomes were fracture union and retention of the original tibial component. Secondary outcomes included knee range of motion (ROM), Knee Society Score (KSS), Hospital for Special Surgery knee score (HSS), radiographic alignment, reduction quality, and surgery-related complications. Longitudinal changes in ROM, KSS, and HSS were evaluated for the overall cohort. No inferential comparison between Felix subtypes was performed. Results All 13 fractures achieved radiographic union, first documented at a mean of 16.4 ± 1.0 weeks. At a mean final follow-up of 20.5 ± 1.6 months, the mean ROM was 122.9 ± 2.2°, the mean KSS was 89.9 ± 3.0, and the mean HSS knee score was 86.7 ± 2.5. All three clinical outcomes differed across the three assessment time points (all P < 0.001). Reduction was graded as good in eight patients and acceptable in five. The original tibial component was retained in all patients. No delayed union, nonunion, fixation failure, reoperation, or revision arthroplasty was recorded. Conclusion In this small retrospective case series, dual locking-plate fixation was followed by fracture union, retention of the original tibial component, maintained alignment, and longitudinal functional improvement in selected Felix type 2A and 3A fractures with a well-fixed component. These findings support the technical feasibility of this approach but do not establish its effectiveness or superiority over alternative treatments.