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

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.