Long Low-profile Proximal Tibial Locking Plate for the Fixation of Periprosthetic Femoral Fractures Above the Prosthesis: A Pilot Study

Background: Anatomic distal femoral Locking Compression Plate (LCP) is generally used to fix distal femoral fractures. However, these plates are not suitable for periprosthetic femoral fracture after Total Knee Arthroplasty (TKA), mainly due to prosthesis impingement. Objectives: In this case series, we report the outcome of proximal tibial LCP fixation in treating periprosthetic femoral fracture after TKA. Methods: Twelve patients with a periprosthetic femoral fracture who underwent surgical treatment were included in this study. According to Su et al. classification, all fractures were type II, originating from the femoral component with proximal extension. Fractures were managed with open reduction and plate fixation. The plate choice was either a long low-profile proximal tibial LCP (n=9) or a short anatomic distal femoral LCP (n=3). Results: The patients were one man and 11 women with a Mean±SD age of 74.5±9.3 years and a Mean±SD follow-up of 2.8±1.3 years. Union of fracture was observed in all fractures fixed with a long locking plate during a Mean±SD period of 3.1±2.1 months. Fixation failed in three patients who were managed with a short plate. These patients underwent revision surgery with a long low-profile proximal tibial LCP. In one of them, the fixation failed again and was finally fixed with a tumor prosthesis. The other two fractures were united with no complications. Conclusion: Long low-profile proximal tibial LCP resolved the impingement problem by prosthesis, caused by short anatomic distal femoral LCP in treating periprosthetic femoral fractures above the prosthesis. However, future large-scale comparative studies are required before recommending LCP for routine implications in these fractures.