Simultaneous management of ipsilateral gonarthritis and ununited tibial stress fracture: combined total knee arthroplasty and internal fixation.
Nonunion of a proximal tibial stress fracture is rare and can be difficult to manage, especially if associated with ipsilateral gonarthritis. Three patients with nonunion of a proximal tibial stress fracture adjacent to an arthritic knee joint were managed by performing simultaneous total knee arthroplasty and internal fixation of the fracture site. The technique involved performing a total knee arthroplasty with angular correction at the site of the extra-articular and intra-articular deformity, bone grafting of the nonunion site, and stabilization of the fracture with a long uncemented intramedullary stemmed tibial component and a unicortical plate. Fibular ostectomy was required during the index surgery in 2 cases to achieve the desired angular correction. In all 3 patients, healing of the nonunion site and limb realignment was achieved. There were no complications or infections associated with the surgery. All patients progressed to full weight bearing at 3 months and had clinical and radiographic union of the nonunion site at 6 months.
Moskal
J T
JT
Roanoke Orthopaedic Center, Roanoke, Virginia 24018, USA.
Mann
J W
JW
D000368:Aged; D001168:Arthritis / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005593:Fracture Fixation, Internal; D015775:Fractures, Stress / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*