Bilateral Distal Tibial Fractures with Preexisting Long-Stem Knee Prostheses Treated with Closed Retrograde Intramedullary Nails: A Case Report

Recently there has been expanded interest in the management of fractures of the ankle in the elderly. This case presentation demonstrates an alternative treatment choice for bilateral distal tibial fractures in a comorbid patient. This is a novel case of interest because low-energy bilateral distal tibial fracture in the elderly and comorbid population is a relatively infrequent occurrence. Several case series have demonstrated the efficacy and safety of closed retrograde nailing of distal tibial fractures. The patient was an 80-year-old woman with a medical history that included hypertension, hyperlipidemia, type 2 diabetes, rheumatoid arthritis, chronic obstructive pulmonary disease, coronary artery disease status post stenting, heart failure with preserved ejection fracture, chronic kidney disease, and a history of a transient ischemic attack. The patient's case was further complicated by the presence of preexisting long-stem bilateral knee prostheses. The patient had been living independently when she experienced a ground-level fall in which imaging showed bilateral distal tibial fractures. The decision to perform closed bilateral concomitant stabilization via retrograde intramedullary nails was based on the need for early ambulation, stability, and the presence of extensive preexisting tibial prostheses. Ultimately, the patient healed uneventfully, returning to a similar level of independence and ambulation as before her injury.