Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 6/2008

01-06-2008 | Case Report

Case Report

Femoral Shaft Fracture Resulting From Femoral Tracker Placement in Navigated TKA

Authors: Peter Bonutti, MD, Daniel Dethmers, MD, James B. Stiehl, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2008

Login to get access

Abstract

Computer-assisted navigation is a surgical tool that may decrease malalignment outliers in TKA. With any new surgical technique, there is the possibility of unexpected complications that raise caution. We report two patients with displaced femoral fractures at optical tracker pin placement sites created for routine performance of navigated TKA. Our experience suggests single bicortical 5-mm pins placed in the femoral shaft have the added risk of creating a stress riser leading to the potential for fracture. Females may have a higher risk for this complication. We believe bicortical pin fixation in the femur or tibia no longer is indicated.
Literature
1.
Bolognesi MP, Hofmann AA. Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res. 2005;440:162–169.PubMedCrossRef
2.
Brooks DB, Burstein AH, Frankel VH. The biomechanics of torsional fractures: the stress concentration effect of a drill hole. J Bone Joint Surg Am. 1970;52:507–514.PubMed
3.
Burstein AH, Currey J, Frankel VH, Heiple JG, Lunseth P, Vessely JC. Bone strength: the effect of screw holes. J Bone Joint Surg Am. 1972;54:1143–1156.PubMed
4.
Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM. Computer assisted total knee replacement. J Bone Joint Surg Br. 2004;86:818–823.PubMedCrossRef
5.
Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty. 2005;20:282–288.PubMedCrossRef
6.
Evans PE, Thomas WG. Tibial fracture through a traction-pin site: a report of two cases. J Bone Joint Surg Am. 1984;66:1475–1476.PubMed
7.
Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res. 2005;433:152–159.PubMedCrossRef
8.
Li CH, Chen TH, Su YP, Shao PC, Lee PS, Chen WM. Periprosthetic supracondylar femoral fracture after total knee arthroplasty with navigation. J Arthroplasty. 2007 September 24; Epub ahead of print.
9.
Jeffrey RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73:709–714.
10.
Johnson BA, Fallat LM. The effect of screw holes on bone strength. J Foot Ankle Surg. 1997;36:446–451.PubMedCrossRef
11.
Jung HJ, Jung YB, Song KS, Park SJ, Lee JS. Fractures associated with computer navigated total knee arthroplasty. J Bone Joint Surg Am. 2007;89:2280–2284.PubMedCrossRef
12.
Krakow K. Total knee arthroplasty using the Stryker Knee Trac system. In: Stiehl JB, Konermann W, Hacker R, eds. Navigation and MIS in Orthopaedic Surgery. Heidelberg, Germany: Springer Verlag; 2006:100–113.
13.
Marchant DC, Rimmington DP, Nusem I, Crawford RW. Safe femoral pin placement in knee navigation surgery: a cadaver study. J Comput Assist Surg. 2004;9:257–260.CrossRef
14.
Mihalko WM, Duquin T, Axelrod JR, Bayers-Thering M, Krackow KA. Effect of one- and two-pin reference anchoring systems on marker stability during total knee arthroplasty computer navigation. Comput Aided Surg. 2006;11:93–98.PubMedCrossRef
15.
Ossendorf C, Fuchs B, Koch P. Femoral stress fracture after computed navigated total knee arthroplasty. Knee. 2006;13:397–399.PubMedCrossRef
16.
Rand JA, Coventry MB. Evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res. 1988;232:168–173.PubMed
17.
Saragaglia D. Computer assisted implantation of a total knee prosthesis without preoperative imaging: the kinematic model. In: Stiehl JB, Konermann W, Hacker R, eds. Navigation and MIS in Orthopaedic Surgery. Heidelberg, Germany: Springer Verlag; 2006:88–94.
18.
Skaggs DL, Leet AI, Money MD, Shaw BA, Hale JM, Tolo VT. Secondary fractures associated with external fixation of pediatric femur fractures. J Pediatr Orthop. 1999;19:582–586.PubMedCrossRef
19.
Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A. Positioning of total knee arthroplasty with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br. 2003;85:830–835.PubMed
20.
Stiehl JB. Transepicondylar distal femoral pin placement in computer assisted surgical navigation. Comput Aided Surg. 2007;12:242–246.PubMedCrossRef
21.
Stulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience of thirty five patients. J Bone Joint Surg Am. 2002;84:90–98.PubMed
Metadata
Title
Case Report
Femoral Shaft Fracture Resulting From Femoral Tracker Placement in Navigated TKA
Authors
Peter Bonutti, MD
Daniel Dethmers, MD
James B. Stiehl, MD
Publication date
01-06-2008
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 6/2008
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-008-0150-6

Other articles of this Issue 6/2008

Clinical Orthopaedics and Related Research® 6/2008 Go to the issue

Original Article

A New Technique to Reattach an Extended Trochanteric Osteotomy in Revision THA Using Suture Cord

Symposium: Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society

Increased Oxacillin Resistance in Thigh Pyomyositis in Diabetic Patients

Orthopaedic • Radiology • Pathology Conference

A Slow-growing Prepatellar Mass in a 31-year-old Woman

Symposium: Selected Papers Presented at the 2007 Meeting of the Musculoskeletal Tumor Society

Selected Papers Presented at the 2007 Meeting of the Musculoskeletal Tumor Society: Editorial Comment

Symposium: Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

Symposium: Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society

Daptomycin Eluted From Calcium Sulfate Appears Effective Against Staphylococcus