{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T05:53:15Z","timestamp":1769925195904,"version":"3.49.0"},"reference-count":15,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,8,12]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:p>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\u2009mm 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.<\/jats:p>","DOI":"10.1136\/bcr-2019-233826","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T19:15:38Z","timestamp":1600802138000},"page":"e233826","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Intraoperative tibial plateau fracture during bone preparation in a cruciate retaining primary total knee arthroplasty"],"prefix":"10.1136","volume":"13","author":[{"given":"Shea K","family":"Taylor","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Sephien","sequence":"additional","affiliation":[{"name":"Morsani College of Medicine, University of South Florida, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Clader","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department, James A Haley Veterans Hospital, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,9,22]]},"reference":[{"key":"2025082723394192000_13.9.e233826.1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-009-0876-9"},{"key":"2025082723394192000_13.9.e233826.2","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.jcot.2018.10.009","article-title":"Intra- operative fractures in primary total knee arthroplasty","volume":"10","author":"Agarwala","year":"2019","journal-title":"J Clin Orthop Trauma"},{"key":"2025082723394192000_13.9.e233826.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2008.04.002"},{"key":"2025082723394192000_13.9.e233826.4","doi-asserted-by":"crossref","first-page":"624","DOI":"10.5435\/JAAOS-D-15-00680","article-title":"Revision total knee arthroplasty for the management of periprosthetic fractures","volume":"25","author":"Kuzyk","year":"2017","journal-title":"J Am Acad Orthop Surg"},{"key":"2025082723394192000_13.9.e233826.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-018-2250-0","article-title":"Periprosthetic tibial fractures in total knee arthroplasty - 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