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 Tibia-18 Patella-0 | 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 Tibia-15 Patella-0 | 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 & Nephew 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 Tibia-30 Patella-0 | 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 | Non-displaced Displaced Displaced | Cemented 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 Supracondylar-1 | 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 Intercondylar-2 | NR | Cemented Stryker Triathlon 4-PS knees 2-semi-constrained | 50% occurred during trialing, while tibia was reduced onto the femur 50% occurred during final implantation | NR |
Huang et al. [6] | Case 1 Case 2 | Medial femoral condyle Lateral femoral condyle | Displaced Displaced | 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 Tibia-12 | 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 Femur-1 | Intercondylar 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 Tibia-13 | 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 | NR |
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 |