Minimally invasive management of a floating prosthesis injury with locking plates

Periprosthetic fractures involving a total knee arthroplasty pose a challenging treatment problem with a prevalence of up to 2.5% in the literature (Instr Course Lect 2001;50:379-389). The supracondylar region of the femur is commonly involved, often with minimal available bone in contact with the components. The clinical challenges are particularly more complex in the case of a combined distal femoral and proximal tibial periprosthetic fracture. This injury is considered a "floating prosthesis" injury because of the complete separation of the prosthesis from the remaining skeleton. In this report, a floating prosthesis injury, in combination with a femoral shaft fracture, is treated with 2 locking plates using a minimally invasive technique, with limited blood loss, immediate pain relief after surgery, and successful healing of all fractures with minimal deformity.