Total knee arthroplasty: Periprosthetic tibial fractures

A classification for periprosthetic tibial fractures is based on the anatomic location of the fracture in reference to the tibial component, whether the fracture occurred during surgery or in the postoperative period, and whether the prosthesis is radiographically well fixed or loose. This classification system and review of experience fostered the development of a treatment algorithm (Fig. 12). In general, postoperative fractures in the setting of a loose prosthesis are best managed by early revision arthroplasty with appropriate fracture fixation. Insertion of a stemmed tibial component and bone grafting of the fracture site are usually sufficient. These same principles may apply to fractures that are discovered intraoperatively. Fractures associated with a well-fixed prosthesis can be treated with closed reduction and casting. Restoration and maintenance of limb alignment is of critical importance. Non-displaced tibial tubercle fractures with intact extensor mechanism function can be treated with extension immobilization; however, internal fixation of displaced tibial tubercle fractures is advised.