Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
BMJ Case Rep. 2020 Sep 22;13(9):e233826. doi: 10.1136/bcr-2019-233826.
Intraoperative fractures are a rare complication in total knee arthroplasty. Limited literature exists in regard to the incidence, mechanism of injury and management of intraoperative fractures. The authors report a unique case of an 80-year-old man who sustained a medial tibial plateau fracture that occurred intraoperatively during final tibia bone preparation with the use of the Woolley Tibia Punch (Innomed, Savannah, Georgia, USA). The fracture was managed with the addition of 4.5 mm cortical lag screws and the addition of a stemmed tibial implant to bypass the fracture. This is the first reported case in literature that describes an intraoperative medial tibial plateau that occurred through the use of a Woolley Tibia Punch. The authors recommend the consideration of drilling to prepare sclerotic bone for cement penetration rather than a punch in order to minimise the potential for intraoperative fractures that may occur with the use of a punch.
术中骨折是全膝关节置换术的一种罕见并发症。关于术中骨折的发生率、损伤机制和处理方法，相关文献有限。作者报告了一例 80 岁男性患者的独特病例，该患者在使用 Woolley 胫骨冲头（美国佐治亚州萨凡纳的 Innomed）进行最后胫骨骨准备时发生了内侧胫骨平台骨折。该骨折通过添加 4.5mm 皮质锁定螺钉和添加带柄胫骨植入物来绕过骨折进行治疗。这是文献中首次报道使用 Woolley 胫骨冲头发生术中内侧胫骨平台骨折的病例。作者建议考虑钻孔准备硬化骨以利于水泥渗透，而不是使用冲头，以尽量减少使用冲头可能导致的术中骨折的发生。
