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Double-plate compound osteosynthesis of a periprosthetic proximal tibial shaft fracture in an elderly patient with Paget's disease using PHILOS and LCP plates

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Bibliographic Details
Title: Double-plate compound osteosynthesis of a periprosthetic proximal tibial shaft fracture in an elderly patient with Paget's disease using PHILOS and LCP plates
Authors: Melinda Schlink, Christian von der Lippe
Source: Trauma Case Reports, Vol 60, Iss , Pp 101275- (2025)
Publisher Information: Elsevier, 2025.
Publication Year: 2025
Collection: LCC:Surgery
Subject Terms: Paget's disease of the bone, Bone fragility, Periprosthetic fracture, Geriatric fractures, Compound osteosynthesis, PHILOS plate, Surgery, RD1-811
Description: Introduction: Paget's disease of the bone (PDB) is characterized by abnormal bone remodeling and accelerated osteoclast activity, weakening bones and leading to deformities, fractures, or osteoarthrosis, commonly involving the tibia. Treating proximal tibial shaft fractures in PDB patients is challenging due to compromised bone quality and unique anatomical considerations. Despite ongoing research, clear guidelines or conclusive evidence on the optimal treatment strategies of these fractures remain limited. Case report: A 91-year-old male presented with severe right knee pain and inability to bear weight after falling down the stairs. Radiographs and computed tomography (CT) revealed a proximal tibial shaft fracture in a patient with prior total knee arthroplasty (TKA) and confirmed PDB. The fracture showed no prosthesis loosening but a deformity of the tibial plateau, making standard fixation unfeasible. The patient underwent an open reduction with double-plate compound osteosynthesis using a proximal humerus internal locking system (PHILOS ®, Depuy Synthes, Zuchwil, Switzerland) and a locking compression plate (LCP ®, Depuy Synthes, Zuchwil, Switzerland). At 6-weeks, he had a pain-free knee with full range of motion and was able to fully weight-bear. Radiographs showed stable fixation with no hardware loosening. Conclusion: In conclusion, double-plate compound osteosynthesis effectively managed a rare periprosthetic proximal tibial shaft fracture in a patient with PDB, achieving stable fixation and enabling immediate postoperative full weight-bearing and fast recovery.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2352-6440
Relation: http://www.sciencedirect.com/science/article/pii/S2352644025001529; https://doaj.org/toc/2352-6440
DOI: 10.1016/j.tcr.2025.101275
Access URL: https://doaj.org/article/b4b970d46dce487b963fe1f1595c9f74
Accession Number: edsdoj.b4b970d46dce487b963fe1f1595c9f74
Database: Directory of Open Access Journals
Description
Abstract:Introduction: Paget's disease of the bone (PDB) is characterized by abnormal bone remodeling and accelerated osteoclast activity, weakening bones and leading to deformities, fractures, or osteoarthrosis, commonly involving the tibia. Treating proximal tibial shaft fractures in PDB patients is challenging due to compromised bone quality and unique anatomical considerations. Despite ongoing research, clear guidelines or conclusive evidence on the optimal treatment strategies of these fractures remain limited. Case report: A 91-year-old male presented with severe right knee pain and inability to bear weight after falling down the stairs. Radiographs and computed tomography (CT) revealed a proximal tibial shaft fracture in a patient with prior total knee arthroplasty (TKA) and confirmed PDB. The fracture showed no prosthesis loosening but a deformity of the tibial plateau, making standard fixation unfeasible. The patient underwent an open reduction with double-plate compound osteosynthesis using a proximal humerus internal locking system (PHILOS ®, Depuy Synthes, Zuchwil, Switzerland) and a locking compression plate (LCP ®, Depuy Synthes, Zuchwil, Switzerland). At 6-weeks, he had a pain-free knee with full range of motion and was able to fully weight-bear. Radiographs showed stable fixation with no hardware loosening. Conclusion: In conclusion, double-plate compound osteosynthesis effectively managed a rare periprosthetic proximal tibial shaft fracture in a patient with PDB, achieving stable fixation and enabling immediate postoperative full weight-bearing and fast recovery.
ISSN:23526440
DOI:10.1016/j.tcr.2025.101275