Intraoperative Tibia Fractures During Primary Total Knee Arthroplasty.

Intraoperative tibia fractures during primary total knee arthroplasty (TKA) are a known complication, however, the management options and outcome are poorly represented in the orthopedic literature. We performed a thorough literature review and detailed two cases of intraoperative tibia fractures during primary TKA at our institution to determine the mechanism behind these injuries and the optimal treatment strategy. We describe one case of intraoperative tibia fracture during primary posterior stabilized (PS) TKA and one case during primary cruciate retaining TKA. Open reduction and internal fixation with plate and screws, lag screws alone, suture anchors, or tension wiring were the most common treatment options reported in the literature. Although there was no consensus on the optimal postoperative protocol, in our series, both cases achieved satisfactory clinical outcomes with and without further fixation of the fracture. Intraoperative tibia fractures are unforeseeable complications during routine primary TKA and the operating surgeon should be aware of the different strategies in managing these complications.

Distal Femoral Replacement Following an Intraoperative Periprosthetic Fracture in a Patient with Prior Bone Mulch ACL Reconstruction.

Periprosthetic distal femur fractures can be treated nonoperatively, with open reduction and internal fixation or with more constrained prostheses. Distal femoral replacement is typically a last resort treatment option for comminuted periprosthetic or osteoporotic distal femoral fractures in patients with poor bone stock or resistant nonunions. We report the case of a 54-year-old female with a remote history of bone mulch ACL reconstruction who sustained an intraoperative comminuted bicondylar distal femur fracture during a primary total knee arthroplasty. This patient was treated with a distal femoral replacement and successfully returned to her preoperative function.