Mind the gap between the tip of the plate and the tibial stem of the revision knee prosthesis – a survey with orthopaedic trauma surgeons
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Purpose In the herein study, we assessed the preferences among experienced orthopaedic surgeons regarding plate size and location when treating a distal tibia fracture in a patient with a revision stem of a total knee prosthesis. We aimed to determine how the stem size of the tibial component of the prosthesis influenced the choices of locking plates. Methods An online-based survey was sent to 35 members of the Brazilian Orthopaedic Trauma Association, consisting of eight multiple-choice questions addressing aspects of the management of lower limb injuries, including two scenarios of fractures of the distal tibia in the presence of a revision stem of a total knee prosthesis. Four large fragment locking plate lengths were used, ranging from 8 to 14 holes, whereas two different stem lengths were used, a 50-mm tibial stem and an 80-mm tibial stem. This gave to the participants 4 possibilities for each experimental situation. Descriptive and inferential analysis of the answers were performed, with a p-value of .05. Results For the 50-mm tibial stem, 48.6% of the surgeons chose the 8-hole plate, while 51.4% chose longer plates (10, 12 or 14-hole) (p > .05). In the presence of an 80-mm stem, the majority (57.1%) of the respondents opted for the 8-hole plate, with 42.9% choosing longer plates (p > .05). The choice for longer plates was more common among more experienced surgeons in treating tibia fractures (> 15 cases a year), and this was statistically significant (88.9% for the 50-mm tibial stem; p = 0.022) and (93.3% for the 80-mm stem; p = 0.014). Conclusion The presence and size of a revision tibial stem in a total knee prosthesis influence the choice of plate length for the fixation of a distal tibia fracture, and there is controversy among orthopaedic surgeons regarding the best construction for the tested scenarios. More experienced surgeons prefer longer plates, and this is statistically significant.
