Combining Plate and Ilizarov Fixation for Tibial Fracture in a 95-Year-Old Woman: A Case Report.

Abstract

BACKGROUND Periprosthetic tibial fractures following total knee arthroplasty (TKA) are increasingly encountered in very elderly patients, where multiple comorbidities and osteoporosis compromise early mobilization and elevate the risk of complications. Maintaining pre-injury activities of daily living (ADL) while ensuring safe surgical management is challenging. We present a case of a 95-year-old woman with a periprosthetic tibial shaft fracture managed with open reduction, additional plate fixation, and Ilizarov external fixation, enabling immediate postoperative weight-bearing. CASE REPORT A 95-year-old woman who sustained a periprosthetic tibial shaft fracture after a fall had been independently ambulatory indoors and used a cane outdoors. On admission, radiographs showed a Felix Type III tibial fracture. Six days after the injury, the fracture was stabilized using Ilizarov external fixator with additional internal fixation using a small locking plate. This combined approach allowed immediate full weight-bearing from the day after surgery. She had no major complications; a minor pin-site infection was managed conservatively. Bone union was confirmed on computed tomography (CT) at 4 months, and the external fixator was removed. At 1 year, radiographs showed good alignment, and she walked independently without a cane. CONCLUSIONS This case demonstrates that combining Ilizarov external fixation with internal plate fixation can enable immediate postoperative weight-bearing and functional recovery, even in very elderly patients with periprosthetic tibial shaft fractures and severe osteoporosis.