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Table 2 Characteristics of the fractures and intra-operative details

From: Intra-operative fractures in primary total knee arthroplasty - a systematic review

Study Location of the fracture Displaced versus non-displaced Type of implant used Time of fracture occurrence Method of fracture management
Alden et al. [2] Femur−49
Medial femoral condyle-20
Lateral femoral condyle-11 Supracondylar femur -8
Medial epicondyle-7
Lateral epicondyle-2
Posterior cortex-1
Lateral tibial plateau-6
Medial tibial plateau-3
Anterior cortex-4
Lateral cortex-3
Medial cortex-10
Posterior cortex-1
64 displaced
3 non-displaced were not detected intra-operatively
All cemented
48 posterior-stabilized (PS)
9 cruciate retaining (CR)
10 with additional constraints
1 distal femoral replacement
26 during exposure and preparation, 22 while trialing, 13 during cementation, and 3 while inserting the poly-ethylene spacer 10 were stable-treated non-operatively
Screws, washers and plate fixation-29; stemmed femoral components-8; stemmed tibial components-8; screws, washers and stems-3; screws, washers, suture-2; suture-2; allograft strut-1; bone graft and cement-1; distal femoral replacement-1; screws and plate-1; stemmed constrained condylar knee component-1; and threaded Steinman pin-1
Agarwala et al. [4] Femur-4
2 medial condyle avulsion
1 lateral condyle
1 medial epicondyle
6 lateral tibial cortex
2 lateral tibial plateau
4 medial tibial plateau
3 anterior tibial cortex
All displaced All cemented
Posterior stabilized Genesis II Smith &
Patella not resurfaced
6-during exposure and bone preparation; 4- during trialing of components; 8-during cementing and final implantation;
1-unknown time
2 medial and 1 lateral femoral condyle fractures with plate and screws; 1 medial epicondyle fracture with screw
Lateral tibial cortex fractures-3 with screws and 3 with sutures; 4 medial tibial plateau fractures and 2 lateral tibial plateau fractures with stemmed tibial component; anterior tibial cortex fractures-1 with screw and 2 with sutures.
Pinaroli et al. [3] Femur-10
Metaphyseal femur-9
Anterior femoral cortex perforation from IM rod-1
Fissures of the tibial plateau-27
Multifragmented epiphyso-metaphysodiaphyseal tibial fracture-1
Tibial tuberosity fracture-2
Tornier Posterior stabilized knee
During impaction of the femoral implant
During intramedullary jig placement
During preparation of the tibial keel or impaction of the tibial implant.
During knee hyperflexion for tibial preparation after tuberosity elevation
During screw fixation after elevation of tuberosity
Stable-delayed weight bearing for 1–2 months
No intervention
Long tibial keel with figure-of-eight wire fixation supported by two screws of 4.5 mm diameter on each side of the keel
Long-stem tibia with plate fixation
Screws reinforced by metallic wires
Hernigou et al. [8] Femur-10 Medial condyle-9
All displaced Cemented PS knee 6 medial condyle fractures associated with PS knee-occurred while placement of the femoral component.
3 medial femoral condyle fractures occurred with a retractor on the posterior aspect of the tibia during tibial implantation
Supracondylar fracture-occurred while trialing in a female patient with hip arthrodesis
Medial condyle fracture fixed with one or two transverse screws
Femoral component with stem extension
Delasota et al. Femur-6 Medial condyle-2
Lateral condyle-2
NR Cemented Stryker Triathlon
4-PS knees
50% occurred during trialing, while tibia was reduced onto the femur
50% occurred during final implantation
Huang et al. [6] Case 1
Case 2
Medial femoral condyle
Lateral femoral condyle
Cemented PS total knee NRG, Stryker
Cemented PS total knee, PFC, Depuy
During trailing of the femoral component, a medial femoral condylar fracture occurred
Occurred at the time of trialing of the femoral component
Reduced and internally fixed with two 6.5 mm × 30 mm cancellous screws
Reduction and internal fixation with two 4.5 mm × 30 mm cancellous screws
Pun et al. [5] Femur-5
Medial femoral condyle-4
Medial cortex of the medial condyle-1
Vertical crack fractures of the anterior cortex of the medial tibial plateau
Minimally displaced
Minimally displaced
Cemented PS NexGen LPS fluted tibial Medial femoral condyle avulsion fracture occurred during removal of the intercondylar notch
Medial cortex of medial femoral condyle fracture- during removal of large osteophyte
Tibial fractures occurred during hammering down of the final tibial component
Multiple 3.5-mm partially threaded AO cancellous screws
Multiple 3.5-mm partially threaded AO cancellous screws
Lombardi et al. [13] Femur-40
Lateral condyle
35 non-displaced
5 displaced
1 displaced
Insall-Burnstein-II posterior stabilized (Zimmer, Warsaw)
Maxim posterior stabilized (Biomet, Warsaw)
Non-displaced fractures identified in post-operative radiographs
Displaced fractures-timing not reported
Angular removal of the trial
Non-displaced fractures identified post-operatively (post-op)-no change in post-op protocol
4 displaced-screw + stemmed component
1 displaced-screw only
Screw only
Berry et al. [12] Femur-23
Most were intercondylar fractures that occur with placement of a PS knee implant-no other details NR NR NR
During tibial preparation, trial reduction, and implant placement
Felix et al. [9] Tibia-10 Type 1C-6
Type IIC-3
Type IIIC-1
NR NR Retraction on bone, tibia preparation, trial reduction, seating of the implant Different techniques-screw fixation, K-wire fixation prior to cementing a stemmed tibia, filling the defect with cement
  1. NR not reported, PS posterior-stabilized