Treatment Algorithm of Felix et al for Treatment of a Fracture in the Tibia Adjacent to a Knee Prosthesis (Mayo Classification)

Felix et al developed an algorithm for the management of a tibial fracture adjacent to a knee prosthesis. The authors are from the Mayo Clinic.

Parameters:

(1) occurrence - intraoperative vs postoperative fracture

(2) type of fracture (Mayo classification)

(3) status

(4) fracture displaced/nondisplaced (if postoperative, Type II or III, secure prosthesis)

Postoperative Fracture

Type	Status	Displaced	Management
I	secure	NA	brace, cast, protected weightbearing
I	loose	NA	revision arthroplasty
II	secure	nondisplaced	brace, cast, protected weightbearing
II	secure	displaced	closed reduction and cast, or ORIF
II	loose	NA	revision arthroplasty
III	secure	nondisplaced	brace, cast, protected weightbearing
III	secure	displaced	closed reduction and cast, or ORIF
III	loose	NA	fracture treatment and revision arthroplasty

Intraoperative Fracture

Type	Status	Management
I	stable	brace, protected weightbearing
I	unstable	screw fixation, stem bypass
II	stable	brace, protected weightbearing
II	unstable	bone graft, stem bypass
III	stable	immobile, protected weightbearing
III	unstable	closed reduction and cast, or ORIF

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