Periprosthetic fractures remain problematic complications after total knee arthroplasty. Treatment options are based on the fixation status of the arthroplasty and the location of the fracture. Fractures typically occur in the distal femur above a well fixed, well functioning total knee arthroplasty. Multiple fixation options exist, including retrograde nailing techniques or some form of plating. Recently, locked plating has gained popularity for the management of these injuries. This paper reviews the principles of management of periprosthetic fractures above a total knee arthroplasty and will highlight the technique of minimally invasive, percutaneous internal fixation of the distal femur using a locked plate.