Intramedullary nail fixation of operative tibia fractures distal to a total knee arthroplasty

This study aims to report the technique and outcomes of operative tibia fractures distal to a total knee arthroplasty (TKA) treated with intramedullary nail fixation (IMN).

Design Retrospective review. Setting 5 Urban Level 1 trauma centers. Patient Selection Criteria Patients with tibia fractures distal to TKA treated with IMN between 2012-2022 and had a minimum of six-months of follow-up or until clinical and radiographic union. Outcome Measures and Comparisons Outcome measures included union, infection, reoperation, and prosthetic complications.

20 patients with a mean follow-up of 12.7 months (range: 3-24) were included in the study. The mean age was 72.4 ± 11.6 years, and majority were females (13/20, 65%). 35% (7/20) had a high-energy fracture. 15 patients sustained midshaft tibia fractures and 5 had a distal-third tibia fracture. Patients were treated using either a suprapatellar, parapatellar, or infrapatellar approach with nail diameter ranging between 8.5 and 10 mm. 16 (80%) patients were post-operatively allowed to weight-bear as tolerated immediately. There was no reported incidence of prosthetic complications or venous thromboembolism. 3 patients had an unplanned re-operation (2 for revision fixation, 1 for debridement). At final follow-up, 1 patient had a malunion, and 2 patients had asymptomatic radiographic delayed union.

Intramedullary nailing of tibia fractures distal to TKA can be performed successfully with low complications with the use of careful surgical technique.