Open reduction with plate and screw fixation was considered to avoid the TKA prosthesis entirely, especially in the setting of radiographic evidence of tibial component subsidence, possible PJI and likely need for revision TKA. Intramedullary tibia nailing after TKA using a modified Tornetta semi-extended approach What are the best next steps in management of this patient? Prior to his injury, erythrocyte sedimentation rate and C-reactive protein were obtained recently in an outpatient setting and were within normal limits. CT scan of the left knee and ankle after immobilization showed a non-displaced posterior malleolar fracture (Figure 1). Radiologic evaluation demonstrated a distal-third spiral tibial shaft fracture with an associated distal fibula fracture below a TKA prosthesis. The patient reported this as his baseline for the past 15 years, along with some varus/valgus instability. Examination of his left knee showed limited active range of motion (ROM) from 0° to 45°. He had a well-healed surgical incision over his knee with no signs of infection. The patient was tender to palpation over his distal tibia and ankle but was neurovascularly intact. On examination, the left leg was moderately swollen with no ecchymosis or open wounds. His left TKA was performed in 2002 and was complicated by periprosthetic joint infection (PJI) in 2003, which was eradicated successfully with debridement, antibiotics and implant retention treatment. His surgical history included three coronary artery bypass grafts, an aortic repair and bilateral total knee arthroplasty. The patient’s past medical history included hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, rheumatoid arthritis and gout. AP (d) and lateral (e) radiographs of left knee demonstrating TKA with evidence of tibial subsidence and axial slice of CT of left lower extremity (f) demonstrating non-displaced posterior malleolar fracture are shown. ![]() Anteroposterior (AP) (a), mortise (b) and lateral (c) radiographs of the left ankle demonstrating distal one-third tibia fracture with associated distal fibula fracture are shown. ![]() He reported baseline numbness to his bilateral lower extremities secondary to diabetic peripheral neuropathy.ġ. The patient was able to drive his motorcycle following the incident but could not ambulate or weight-bear on his left lower extremity. If you continue to have this issue please contact to HealioĪ 75-year-old man presented to the ED with left ankle pain after a low-speed fall off a motorcycle that resulted in a twisting injury to his left leg.
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