{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T06:19:17Z","timestamp":1787552357687,"version":"build-2736575974"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>With the aging global population, periprosthetic and post-arthroplasty femoral shaft fractures are becoming increasingly common. Although intramedullary nailing remains one of the classic surgical procedures for treating femoral shaft fractures in many cases, the presence of an unexpected space-occupying lesion within the medullary canal may often increase the surgical difficulty. This paper reports a case of a femoral fracture occurring 10 years after ipsilateral total knee arthroplasty in an 83-year-old female. On preoperative plain radiographs and CT, no clear intramedullary lesion was identified. However, during the subsequent fracture surgery, a dense polymethyl methacrylate (bone cement) plug was encountered that completely blocked reaming and nail insertion. The surgery was ultimately completed by using a side plate for fixation. This case indicates that radiolucent cement plugs retained from prior joint surgery may be missed on preoperative imaging. Orthopedic surgeons must therefore maintain a high index of suspicion and always have alternative fixation strategies available to manage such intraoperative crises effectively.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1939276","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:28:02Z","timestamp":1787549282000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Occult cement plug causing femoral canal obstruction during nailing after TKA: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Yanhui","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongliang","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Feicheng Hospital of Traditional Chinese Medicine","place":["Taian, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingxiang","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingkuan","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Huantai County People\u2019s Hospital","place":["Zibo, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hematology, Dongping County People\u2019s Hospital","place":["Taian, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.asjsur.2012.06.011","article-title":"Routine use of antibiotic prophylaxis in low-risk laparoscopic cholecystectomy is unnecessary: a randomized clinical trial","volume":"35","author":"Shah","year":"2012","journal-title":"Asian J Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e64","DOI":"10.1097\/BOT.0000000000001332","article-title":"Nail plate combination technique for native and periprosthetic distal femur 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Sci"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1939276\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:28:02Z","timestamp":1787549282000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1939276\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":11,"alternative-id":["10.3389\/fsurg.2026.1939276"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1939276","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1939276"}}