Wu Jiangpeng, Li Zheng, Huang Jiang, Jiao Xufeng, Cao Guanglei
Department of Orthopedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Front Surg. 2023 Jan 6;9:987953. doi: 10.3389/fsurg.2022.987953. eCollection 2022.
The incidence of periprosthetic fractures after total knee arthroplasty (TKA) increases in parallel with the number of procedures. Comminuted fractures along the primary fracture line extending to the edge of the prosthesis are challenging, and bilateral fractures are rarely reported, especially with open injuries.
A 65-year-old female had undergone bilateral TKA in our hospital 5 years before admission. She was admitted with a traumatic bilateral Rorabeck type II B distal femur periprosthetic fracture (closed right, open left, Gustilo II) and was treated with bilateral staged open reduction and internal fixation (ORIF) with double-locking plates. The patient experienced a prolonged delayed fracture union and finally healed around 21 months postoperatively. The function was satisfactory after 4 years of follow-up.
ORIF with double-locking plates can be used to treat Rorabeck II B periprosthetic fracture where the primary fracture line extends beyond the edge of the prosthesis; however, there may be delayed healing or nonunion. Patients need to undergo long-term rehabilitation and endure long disability times and require good rehabilitation nursing care. Once they achieve bone healing, the treatment achieves bone preservation and substantial prosthesis survival.
全膝关节置换术（TKA）后假体周围骨折的发生率随手术数量的增加而上升。沿主要骨折线延伸至假体边缘的粉碎性骨折具有挑战性，双侧骨折鲜有报道，尤其是开放性损伤的双侧骨折。
一名65岁女性在入院前5年于我院接受了双侧TKA。她因创伤性双侧Rorabeck II B型股骨远端假体周围骨折（右侧闭合，左侧开放，Gustilo II型）入院，并接受了双侧分期切开复位内固定术（ORIF），使用双锁定钢板。患者经历了长时间的延迟骨折愈合，最终在术后约21个月愈合。随访4年后功能满意。
双锁定钢板的ORIF可用于治疗主要骨折线延伸至假体边缘以外的Rorabeck II B型假体周围骨折；然而，可能会出现延迟愈合或不愈合。患者需要接受长期康复治疗，忍受较长的残疾时间，并需要良好的康复护理。一旦实现骨愈合，治疗可实现骨保留和假体的长期存活。
