Long Low-profile Proximal Tibial Locking Plate for the Fixation of Periprosthetic Femoral Fractures Above the Prosthesis: A Pilot Study

Abstract

Background: Anatomic distal femoral plates locking compression plate (LCP) are generally used for the fixation of distal femoral fractures. However, they are not suitable for periprosthetic femoral fracture after total knee arthroplasty (TKA), mainly owing to the impingement with prosthesis. Objectives: In this case series, we report the outcome of proximal tibial LCP fixation in the treatment of periprosthetic femoral fracture after TKA. Patients and Methods: Twelve patients with a periprosthetic femoral fracture who underwent surgical treatment were included. According to Su et al. classification, all fractures were type II, originating from the femoral component with proximal extending. Fractures were managed with open reduction and plate fixation. The plate choice was either a long low-profile proximal tibial LCP (n=9) or a short anatomic distal femoral LCP (n=3). Results: The study population included one male and 11 females with a mean age of 74.5±9.3 years and a mean follow-up of 2.8±1.3 years. Union of fracture was observed in all fractures that were fixed with a long locking plate during a mean period of 3.1±2.1 months. Fixation failed in all three patients who were managed with a short plate. These patients underwent revision surgery with a long low-profile proximal tibial LCP. In one of them, the fixation failed again and finally fixed with tumor prosthesis. The other two fractures were united with no complications. Conclusion: Long low-profile proximal tibial LCP omits the problem of impingement by prosthesis, which is caused by short anatomic distal femoral LCP in the treatment of periprosthetic femoral fractures above the prosthesis. However, future large-scale comparative studies are required before we can recommend it for routine implications in these fractures.