A rare case of interprosthetic tibia fracture

Case history

A 64-year old female with no comorbidities fell in the woods and sprained her ankle. She had previously undergone knee replacement years ago and ankle replacement surgery only 3 months ago.

Clinical findings

She presented with swelling, pain, loss of motion in the ankle joint and was unable to bear weight. There was no sign of compartment syndrome or bullose oedema. Distal neurocirculatory status was intact.

Investigation/Results

X-ray revealed a spiral distal tibia fracture. Additional CT scan revealed a non dislocated distal fibula fracture as well, the tibial fracture line went to the tip of the tibial prosthetic component of the ankle arthroplasty.

Diagnosis

A diagnosis of interprosthetic tibia fracture and non dislocated fibula fracture was made.

Therapy and Progressions

Due to good fragment position and no direct signs of prosthetic instability a decision was made to treat conservatively. Firstly with a non weight bearing cast for 7 weeks, during this time regular x-rays were made and no fragment dislocation was observed. We continued with a walking boot and partial weightbearing in regard to pain. Full weight bearing was allowed at week 10 and the walking bood was removed at week 12. Afterwards a 2 week in house physical rehabilitation was completed at a local thermal spa, followed by ambulatory physical therapy. X-rays at 5 months showed healing by callus, the patient made a full recovery with normal gait without assistance and no pain was observed. Minor residual swelling was noted.

Comments

By following basic principles, having a meticulous follow up and low threshold for surgery some individual cases can be effectively treated conservatively.

References

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