Optimizing Dual-Plate Fixation of Distal Femoral Periprosthetic Fractures Using a Distal Tibial Metaphyseal Plate

Distal femoral periprosthetic fractures following total knee arthroplasty (TKA) are complex and technically demanding injuries in orthopedic trauma surgery. With the increasing prevalence of TKA in an aging population, the incidence of these fractures has risen steadily. This study aims to share our experience of implant selection and surgical strategy, which provides an alternative and out-of-the-box thinking process for fracture fixation.

Between 2022 and 2024, 10 consecutive patients with distal femoral periprosthetic fractures involving a well-fixed femoral component were treated using a dual-plate construct incorporating a distal tibial metaphyseal locking plate for medial augmentation and distal femoral plate. Clinical, radiographic, and functional outcomes were retrospectively collected and analyzed.

All patients were followed for a minimum of 12 months. Radiographic callus formation was observed at approximately 2 months postoperatively, and fracture union was achieved at a mean of 4 months. No cases of fixation failure, nonunion, or deep infection were observed during the follow-up period. Favorable functional outcomes were also noted at final follow-up.

The use of a dual-plating construct that may provide enhanced mechanical stability was well established, allowing early mobilization and progression to weight-bearing. The distal tibial metaphyseal plate, which even though was not designed original for treating such kind of fracture, demonstrated good anatomical conformity to the medial distal femur and may serve as a practical option for medial augmentation. Orthopedic surgeons should not be constrained by the designation of a plate as an "anatomical plate"; rather, they should make judicious use of the implants available and apply them in the manner most appropriate for the specific fracture pattern. Using distal tibial metaphyseal plate as medial augmentation in dual-plate fixation appears to be a feasible and promising strategy for managing distal femoral periprosthetic fractures following TKA.