Shukla Tapish, Vaish Abhishek, Vaishya Raju, Patralekh Mohit Kumar
Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi, 110076, India.
Chief Medical Officer & Orthopaedic Surgeon, Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India.
J Clin Orthop Trauma. 2022 May 11;29:101892. doi: 10.1016/j.jcot.2022.101892. eCollection 2022 Jun.
Periprosthetic tibial fractures in Total Knee Arthroplasty are much less commonly seen than femoral fractures, and there is a paucity of available literature and management recommendation for these fractures. We aimed to identify the relevant and up-to-date literature on this subject to analyse the incidence, risk factors, and management recommendations.
A literature search was done on the databases of PubMed and SCOPUS using appropriate keywords. All the published literature in the English language was included for this review.
We included 21 studies comprising 260 tibial periprosthetic fractures (91 intra-operative (35%) and 169 (65%) post-operative or delayed fractures). Only 5.9% of these fractures were managed conservatively. Whereas 98 cases (58%) were managed with open reduction and internal fixation (ORIF) with plating, 19 (11.2%) were managed with revision TKA. Seventeen cases (10%) were managed with minimally invasive percutaneous plate osteosynthesis (MIPPO), and 8 (4.7%) were managed with intramedullary nailing. Less than 6% of cases were managed with other means, viz. megaprosthesis (n = 4), arthrodesis (n = 5), amputation (n = 1), and external fixator (n = 1).
Intraoperative fractures accounted for one-third of the fractures in our review. A majority of the delayed periprosthetic fractures were treated with surgical intervention. The most preferred surgical treatment method was ORIF of fractures using locking plates (either open or MIPPO). Revision TKA or megaprosthesis was used in cases with the loosened implants in association with the fracture.
IV.
全膝关节置换术中假体周围胫骨骨折的发生率远低于股骨骨折，且针对此类骨折的可用文献和治疗建议较少。我们旨在查找有关该主题的相关最新文献，以分析其发生率、危险因素和治疗建议。
使用适当的关键词在PubMed和SCOPUS数据库中进行文献检索。本次综述纳入所有以英文发表的文献。
我们纳入了21项研究，共260例胫骨假体周围骨折（91例术中骨折（35%）和169例术后或延迟骨折（65%））。这些骨折中只有5.9%采用保守治疗。而98例（58%）采用切开复位内固定（ORIF）加钢板固定治疗，19例（11.2%）采用全膝关节置换翻修术治疗。17例（10%）采用微创经皮钢板接骨术（MIPPO）治疗，8例（4.7%）采用髓内钉固定治疗。不到6%的病例采用其他方法治疗，即使用大型假体（n = 4）、关节融合术（n = 5）、截肢术（n = 1）和外固定架（n = 1）。
在我们的综述中，术中骨折占骨折总数的三分之一。大多数延迟性假体周围骨折采用手术干预治疗。最常用的手术治疗方法是使用锁定钢板对骨折进行切开复位内固定（无论是切开还是MIPPO）。对于假体松动合并骨折的病例，采用全膝关节置换翻修术或大型假体置换。
IV级。
