Combination-type periprosthetic tibial fracture: Felix type (II+IV)A

Abstract

Tibial periprosthetic fractures are rare but present a complicated problem for orthopaedic surgeons. Literature in relation to combination-type periprosthetic fractures is extremely scarce, and there is limited guidance available on its treatment. We report the case of a woman in her 60s, whose radiographs revealed a periprosthetic fracture of the tibia, which was a Felix type (II+IV)A fracture. The tibial tuberosity fragment was fixed with a cannulated cancellous screw. The fracture adjacent to the stem was managed conservatively as the prosthesis was stable. Follow-up radiographs revealed both fractures to have healed completely by 12 weeks. The patient returned to preinjury functional levels by 4 months. Our demonstrated treatment of a Felix type II+IV periprosthetic fracture could be a viable treatment option for such fractures.

Keywords: orthopaedic and trauma surgery; orthopaedics.

Figure 1

Radiographs of right knee. (A) Anteroposterior and (B) lateral radiographs showing the periprosthetic tibial fracture. Fracture is seen involving the tibial tuberosity, with the fragment displaced anteriorly. The prosthesis appears stable and well aligned.

Figure 2

Postoperative radiographs of right knee. (A) Anteroposterior and (B) lateral radiographs postsurgery showing an anteroposteriorly placed partially threaded cannulated cancellous screw for the tibial tuberosity fragment. Undisplaced fracture is also noted passing through the stem. (C) Anteroposterior and (D) lateral radiographs at 12 weeks of follow-up postsurgery showing complete union of both fracture lines.