Management of Tibial Shaft Fractures Distal to TKA Prosthesis by Intramedullary Nail: A Report of Three Cases
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CASE REPORT
Management of Tibial Shaft Fractures Distal to TKA Prosthesis by Intramedullary Nail: A Report of Three Cases A. Devendra1 · Nishith P Gupta1 · Mohd Zackariya Jaffrulah1 · B. R. W. Armstrong1 · J. Dheenadhayalan1 · S. Rajasekaran1 Received: 22 March 2020 / Accepted: 10 May 2020 © Indian Orthopaedics Association 2020
Abstract Introduction Diaphyseal tibial fractures distal to a well-fixed tibial component although rare present a significant challenge and optimal treatment remains controversial. Displaced periprosthetic tibial shaft fractures are ideally treated with open reduction internal fixation with plate osteosynthesis. However, this treatment method is associated with weight-bearing restrictions, which can be difficult for elderly patients with multiple comorbidities and balance impairment. We present our experience of internal fixation with an intramedullary nail that uses an inferior entry point, standard intramedullary tibial nail, and conventional instrumentation. Materials and methods Between 2017 and 2018, three patients with acute tibial shaft fractures distal to a TKA (Felix Type 3A) were treated with an intramedullary nail. Preoperative planning involved assessing proximal tibia to ensure adequate room for implant and instrumentation. The average patient age was 66.3 years (range 59–72 years) and all patients were males. All the patients sustained fractures of distal tibial and fibula diaphysis, after a road traffic accident. There were no complications intraoperatively, and all procedures were completed uneventfully. One patient underwent additional fixation of the fibula. Results All patients achieved a radiological fracture union after an average of 20.6 weeks. There were no fixation failures, or nonunions postoperatively. There were no new symptoms relative to the TKA that could be attributed to the tibial nailing procedure. Conclusion We recommend that this technique can be used primarily for this fracture pattern distal to a TKA, provided there is adequate space to accommodate the nail and instrumentation proximally anterior to the tibial tray.
* A. Devendra [email protected] 1
Division of Orthopaedics And Trauma, Ganga Hospital, 313 Mettupalayam Road, Coimbatore 641043, India
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Vol.:(0123456789)
Indian Journal of Orthopaedics
Graphic abstract
Keywords Total knee arthroplasty · Tibia fracture · Periprosthetic fracture · Intramedullary nailing
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Indian Journal of Orthopaedics
Introduction
Preoperative Planning
Total knee arthroplasty (TKA) is currently one of the most common adult reconstructive procedures world over [1]. According to Frost and Sullivan’s research, the arthroplasty market in India was expected to grow at a compound annual growth rate of 26.7% during 2010–2017. According to this survey, almost 70,000 joint replacement surgeries were performed in India in the year 2011. With the rising geriatric population and increased utilization in younger patients, this number is expected to double within the next decade [2]. In contrast to
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