Florida Orthopaedic Institute, Tampa, FL, United States.
Vanderbilt University, Nashville, TN, United States.
Injury. 2019 Apr;50(4):978-982. doi: 10.1016/j.injury.2019.03.014. Epub 2019 Mar 15.
The incidence of periprosthetic fractures after total knee arthroplasty (TKA) is rising due to an increasing number of TKAs performed annually and the growing elderly population. Like periprosthetic fractures of the distal femur, periprosthetic tibia fractures are primarily treated with operative fixation; however, there is limited scientific literature that has reported outcomes of periprosthetic tibia fractures treated with modern plating techniques. To our knowledge, this is the largest series of non-intraoperative periprosthetic tibia fractures treated with open reduction internal fixation (ORIF) ever reported.
Retrospective chart review of 4557 operatively treated tibia fractures with ORIF over a 16-year period at two Level 1 Trauma Centers.
38 patients with an average follow-up of 15.3 months (range 3-24) were identified. 11 (28.9%) fractures were in the proximal tibia (four with extension into the plateau (Felix 1A) and seven adjacent to the tibial stem (Felix 2A)), six (15.8%) in the midshaft/diaphysis (Felix 3A), and 21 (55.3%) in the distal 1/3rd (metaphysis, Felix 3A). 76.3% (29/38) of fractures united by 6 months following the index procedure, leaving 9 nonunions. The overall re-operation rate was 31.6% (12/38). There were no significant differences in rates of union (p = 1.00), reoperation (p = 0.66), superficial infection (p = 0.66), or deep infection (p = 0.31) in patients treated with single versus dual plating.
Periprosthetic tibia fractures are difficult to treat and have a high risk of nonunion and reoperation even with modern plating techniques. Most patients can be treated to union with operative fixation and do not require revision arthroplasty, if the components are stable initially. We recommend dual plating for fractures in the proximal third, and either single plating or nailing for fractures in the middle and distal thirds depending on bone quality, implant positioning, and fracture morphology.
由于每年进行的 TKA 数量增加和老年人口的增长，全膝关节置换术后（TKA）的假体周围骨折发病率正在上升。与股骨远端假体周围骨折一样，假体周围胫骨骨折主要通过手术固定治疗；然而，目前科学文献中很少有报道采用现代接骨板技术治疗假体周围胫骨骨折的结果。据我们所知，这是迄今为止报道的最大系列非术中假体周围胫骨骨折采用切开复位内固定（ORIF）治疗的病例。
回顾性分析了 16 年间在两个 1 级创伤中心接受 ORIF 治疗的 4557 例胫骨骨折患者的病历。
确定了 38 例平均随访 15.3 个月（范围 3-24 个月）的患者。11 例（28.9%）骨折位于胫骨近端（其中 4 例延伸至平台（Felix 1A），7 例位于胫骨干附近（Felix 2A）），6 例（15.8%）位于中段/骨干（Felix 3A），21 例（55.3%）位于远端 1/3 处（干骺端，Felix 3A）。76.3%（29/38）例骨折在索引手术后 6 个月内愈合，留下 9 例骨不连。总的再次手术率为 31.6%（12/38）。在接受单钢板和双钢板治疗的患者中，愈合率（p=1.00）、再手术率（p=0.66）、浅表感染率（p=0.66）和深部感染率（p=0.31）无显著差异。
即使采用现代接骨板技术，假体周围胫骨骨折也难以治疗，且存在很高的不愈合和再手术风险。如果最初的关节假体组件稳定，大多数患者可以通过手术固定治疗达到愈合，而无需进行翻修手术。我们建议对于近端三分之一的骨折采用双钢板固定，对于中、远端三分之一的骨折，根据骨质量、植入物定位和骨折形态，选择单钢板固定或髓内钉固定。
