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  • 3.3 Tibial Fractures

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    Maria Mashka
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    This document discusses the classification and treatment of periprosthetic fractures of the tibia. It notes that tibial fractures occur less frequently than distal femur fractures after total knee replacement. Fractures are classified based on their location relative to the prosthesis into Types I-IV. Type I fractures involve the tibial plateau while Types II-III occur around or distal to the prosthesis. Treatment depends on the type and stability of the prosthesis, with fixation typically used for stable implants and revision for loose implants. Locking plates are commonly used but treatment requires a flexible "toolbox" approach depending in the individual case.

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    Tibial Fractures

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    This document discusses the classification and treatment of periprosthetic fractures of the tibia. It notes that tibial fractures occur less frequently than distal femur fractures after total knee replacement. Fractures are classified based on their location relative to the prosthesis into Types I-IV. Type I fractures involve the tibial plateau while Types II-III occur around or distal to the prosthesis. Treatment depends on the type and stability of the prosthesis, with fixation typically used for stable implants and revision for loose implants. Locking plates are commonly used but treatment requires a flexible "toolbox" approach depending in the individual case.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    20 views19 pages

    3.3 Tibial Fractures

    Uploaded by

    Maria Mashka
    This document discusses the classification and treatment of periprosthetic fractures of the tibia. It notes that tibial fractures occur less frequently than distal femur fractures after total knee replacement. Fractures are classified based on their location relative to the prosthesis into Types I-IV. Type I fractures involve the tibial plateau while Types II-III occur around or distal to the prosthesis. Treatment depends on the type and stability of the prosthesis, with fixation typically used for stable implants and revision for loose implants. Locking plates are commonly used but treatment requires a flexible "toolbox" approach depending in the individual case.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 19

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

    1B
    Revision

    Type 2
    2A
    Fixation most often
    Proximal fixation is very
    challenging but important
    Locking plate (maybe two)
    Soft tissues !!!!!!!

    2B
    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 periprosthetic fracture

    Type 2
    Fixation or revision
    ?
    Basic principles also
    apply to periprosthetic fracture
    Stability, bridging,
    restoring length,
    axis and rotation

    Type 2 B
    Fixation or revision
    ?
    Basic principles also
    apply to periprosthetic fracture
    Stability, bridging,
    restoring length,
    axis and rotation
    Healing

    Type 3
    3A
    Fixation

    Type 3
    3A
    Fixation
    Same as 2 A

    3B
    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

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