Traumaplasty in Action: Staggered Bilateral Primary Total Knee Arthroplasty for Complex Proximal Tibial Fractures...

Proximal tibial fractures in elderly patients with coexisting advanced knee osteoarthritis pose a significant treatment challenge. Primary total knee arthroplasty (TKA) has emerged as a viable alternative in selected cases, offering stable fixation, early mobilization, and avoidance of staged procedures. To the best of our knowledge, this is the first reported case of bilateral primary TKA performed for bilateral proximal tibial metaphyseal fractures with bilateral tibial tubercle avulsions in the setting of advanced osteoarthritis.

We report the case of a 68-year-old male who sustained bilateral proximal tibial metaphyseal and fibular fractures with associated tibial tubercle avulsions and advanced bilateral knee osteoarthritis following a fall. After thorough evaluation, the patient underwent staggered bilateral primary TKA in a single admission. Tibial stem extenders were used to bypass the fracture sites, and tibial tubercle fixation was achieved with low-profile plates. Post-operative rehabilitation included early mobilization, progressive weight-bearing, and structured physiotherapy. At 1-year follow-up, the patient demonstrated excellent functional recovery with good knee range of motion and independent ambulation.

Primary TKA in the fracture setting can obviate the need for complex secondary procedures, reduce complication risks, and restore function more efficiently than conventional fixation in carefully selected patients. Meticulous pre-operative planning, careful patient optimization, surgical expertise, and the adjunctive use of advanced technologies such as robotics are critical to achieving optimal outcomes.