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Ermutlu C, Göksel F, Eken G. Treatment of Periarticular Fractures of the Knee Using the Less Invasive Stabilization System: A Retrospective Clinical Trial. Cureus 2020; 12:e7773. [PMID: 32461848 PMCID: PMC7243630 DOI: 10.7759/cureus.7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Periarticular fractures of the knee in adults are generally treated with internal fixation. The Less Invasive Stabilization System (LISS) plate, developed by Arbeitsgemeinschaft Osteosynthesefragen (AO)/Association for the Study of Internal Fixation (ASIF) in the late 1990s, allows reduction and biological fixation through smaller incisions without violating periosteal blood supply. It offers several advantages for the treatment of complex periarticular fractures of the knee. In this study, we have aimed to report the results of a single series of these fractures. Materials and methods Forty-eight patients with AO type 33 and AO type 41 periarticular knee fractures who were operated between 2009 and 2014 at a single institution were included in this retrospective study. Patient demographics, fracture epidemiology, intraarticular extension, concomitant injuries, American Society of Anesthesiologists (ASA) score, time to union, the average time from admission to surgery, and the mean time from operation to patient discharge were noted. The effect of patient and fracture-related factors on length of hospital stay were evaluated. Results The mean follow-up time was 23.7 (12-48) months. The average time from admission till surgery and from surgery till discharge was 10.2 (1-39) and 9.7 (2-35) days, respectively. The average time for union was 6.8 months. Femur fractures healed in mean 6.6 months whereas tibia fractures took 7.1 months to heal. Time from admission to surgery and postoperative hospital stay was longer in patients with higher ASA scores (p<0.01) and open fractures (p<0.001). Patients’ body mass index (BMI) and intraarticular extension of the fracture did not cause an increase in either preoperative or postoperative hospital stay (p>0.05). The presence of concomitant major injuries caused a delay in operation (p<0.05), whereas postoperative hospital stay was not different (p>0.05). Conclusion LISS plating provides good stability through a small incision, permits biological fracture healing, may be used in multifragmentary fractures and has low complication rates. It is a good alternative for the treatment of periarticular fractures of the knee.
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Affiliation(s)
- Cenk Ermutlu
- Orthopaedics, Bursa Uludag University School of Medicine, Bursa, TUR
| | - Ferdi Göksel
- Orthopaedics and Traumatology, Özel Karadeniz Ereğli Anadolu Hospital, Zonguldak, TUR
| | - Gökay Eken
- Orthopaedics and Traumatology, Bursa Acıbadem Hospital, Bursa, TUR
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Minimally invasive plate osteosynthesis with locking compression plate in patients with Vancouver type B1 periprosthetic femoral fractures. Injury 2018; 49:1336-1340. [PMID: 29807829 DOI: 10.1016/j.injury.2018.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) remain one of the most challenging complications to address. Although the principal treatment modalities for Vancouver type B1 fractures are open reduction and internal fixation (ORIF), surgeons have not yet reached a consensus on the optimal method for reduction and fixation. We therefore investigated whether minimally invasive plate osteosynthesis (MIPO) using locking compression plate (LCP) would lead to favorable outcomes for patients with Vancouver type B1 PFFs. In addition, we also compared the outcomes of patients treated with MIPO to those treated with ORIF. METHOD We retrospectively evaluated the clinical and radiographic outcomes of a series of 21 Vancouver type B1 PFFs treated with MIPO and LCP between February 2011 and February 2017. The mean duration of follow-up was 33.8 months. We also compared outcomes of these patients to those of patients with 19 Vancouver type B1 fractures treated with ORIF between April 2006 and December 2011. RESULTS Fracture healing without complications was achieved in 20 (95.2%) out of 21 cases in the MIPO group and in 14 (87.5%) out of 16 cases in the ORIF group. There was one case of fixation failure with stem subsidence in the MIPO group. In the ORIF group, there were 2 nonunion with metal failure. Operation time was significantly shorter and intraoperative blood loss was significantly less in the MIPO group compared to the ORIF group. However, there were no significant differences in frequency of transfusion, time-to-union, walking abilities, modified Harris hip score, or complications. CONCLUSION The radiological and clinical outcomes of MIPO using LCP in patients with Vancouver type B1 PFFs were shown not to be inferior to ORIF and resulted in fewer intraoperative complications than ORIF. If care is taken regarding the stability of femoral implant and optimal surgical techniques, MIPO may be a recommended option in the treatment of Vancouver type B1 periprosthetic fracture.
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Nagwadia H, Joshi P. Outcome of osteosynthesis for periprosthetic fractures after total knee arthroplasty: a retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:683-690. [PMID: 29299767 DOI: 10.1007/s00590-017-2121-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Incidence of periprosthetic fractures around knee is going to rise in near future due to dramatic increase in total knee arthroplasty (TKA). Our study is a retrospective case series describing the outcome of osteosynthesis for periprosthetic fractures after TKA. MATERIALS AND METHODS We analyzed the outcome of osteosynthesis for periprosthetic fractures with stable implants in 43 patients having 45 fractures operated between 2010 and 2015. RESULTS Out of 43 patients, the majority were female (M-15, F-28) with mean age of 65.95 years, majority had left knee involved (L-24, R-19), with fractures involving femur, tibia and patella, respectively, in 29, 11 and 5 patients. Fracture pattern was Rorabeck type 2 in 29, Felix type 2 in 6, type 3 in 5, Goldberg type 2 in 3, type 3a in 2, Unified classification system type A in 2, B1 in 35, C in 4, E in 2 cases. Anterior femoral cortex notching was found in 13 patients with femoral fractures. According to Tayside classification, 12 patients had type 1 and one had type 2 notching. Different implants were used according to the need of the fractures. After TKA, the mean Hospital for Special Surgery score was 84.2, which reduced to mean 76 at 9 months following osteosynthesis. Three patients had nonunion, one had delayed union and one had implant failure. CONCLUSIONS Osteosynthesis for periprosthetic fractures around knee with locked compression plate gives promising results. Fractures involving patella are associated with inferior functional outcome. Understanding the fracture pattern and bone stock available for fixation with correct choice of implant and correct surgical technique gives promising outcome in periprosthetic fractures around knee.
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Affiliation(s)
- Hasmukh Nagwadia
- Department of Orthopaedics, Shalby Hospital, Opp. Karnavati Club S G Road, Ahmedabad, Gujarat, 380015, India
| | - Prateek Joshi
- Department of Orthopaedics, Atharva Orthopaedic Superspeciality Hospital, New Vadaj, Ahmedabad, Gujarat, 380013, India.
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Gavanier B, Houfani F, Dumoulin Q, Bernard E, Mangin M, Mainard D. Osteosynthesis of periprosthetic type A and B femoral fractures using an unlocked plate with integrated cerclage cable and trochanteric hook: A multicenter retrospective study of 45 patients with mean follow-up of 20 months. Injury 2017; 48:2827-2832. [PMID: 29100663 DOI: 10.1016/j.injury.2017.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral periprosthetic fracture (FPF) is a frequent complication in dependent elderly persons, with a limited life expectancy. Their management is difficult and the choice between osteosynthesis and prosthesis is still matter of discussion. To date, there is no study on unlocked plate with integrated cerclage cable and trochanteric hook for this indication. The objectives of this study were to analyze fracture healing, complication rate and functional outcome. Our hypothesis is that this technique allows a high rate of consolidation and a return to the previous state in terms of autonomy and place of residence. MATERIALS AND METHODS We conducted a retrospective multicenter study between 2010 and 2015. The inclusion criteria were: patients with type A and B FPF according to the classification of Vancouver who received osteosynthesis hook plate. The evaluation focused on the consolidation period, complications and pre and postoperative Parker and Katz scores. Death, nonunion, dislocation, infection and failure of fixation were considered major complications. RESULTS Forty-five patients met the inclusion criteria and were evaluated at mean 20 months (6-72). All fractures consolidated at a mean 7 weeks (6-10), except one that has not undergone further surgery in the absence of functional impairment. Parker score decreased from 6.4 to 4.9 (p=0.03) and Katz score from 4.8 to 4.3 (p=0.045). Five patients died within the year of the operation. Five patients living at home preoperatively were admitted to an institution, the others returned to their retirement home or nursing home. CONCLUSION This plate allows for a quick and effective management of patients with FPF. The low rate of complications and the very good consolidation rate lead us to use the same plate even for class B2 or B3 fractures in some patients with precarious health condition who cannot tolerate major revision surgery: Elderly, ASA score >3, loss of autonomy, Katz score <4.
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Affiliation(s)
- B Gavanier
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - F Houfani
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - Q Dumoulin
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - E Bernard
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - M Mangin
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - D Mainard
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
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Donnelly KJ, Tucker A, Ruiz A, Thompson NW. Managing extremely distal periprosthetic femoral supracondylar fractures of total knee replacements - a new PHILOS-ophy. World J Orthop 2017; 8:809-813. [PMID: 29094012 PMCID: PMC5656497 DOI: 10.5312/wjo.v8.i10.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/15/2017] [Accepted: 09/04/2017] [Indexed: 02/06/2023] Open
Abstract
We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type III peri-prosthetic femoral fractures in relation to a total knee replacement (TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System (PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up (6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.
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Affiliation(s)
- Kevin J Donnelly
- Department of Trauma and Orthopaedic Surgery, Altnagelvin Hospital, Londonderry BT47 6SB, Northern Ireland, United Kingdom
| | - Adam Tucker
- Department of Trauma and Orthopaedic Surgery, Altnagelvin Hospital, Londonderry BT47 6SB, Northern Ireland, United Kingdom
| | - Angel Ruiz
- Department of Trauma and Orthopaedic Surgery, Altnagelvin Hospital, Londonderry BT47 6SB, Northern Ireland, United Kingdom
| | - Neville W Thompson
- Department of Trauma and Orthopaedic Surgery, Altnagelvin Hospital, Londonderry BT47 6SB, Northern Ireland, United Kingdom
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Brand S, Bauer M, Petri M, Schrader J, Maier HJ, Krettek C, Hassel T. Impact of intraprosthetic drilling on the strength of the femoral stem in periprosthetic fractures: A finite element investigation. Proc Inst Mech Eng H 2016; 230:675-81. [PMID: 27272200 DOI: 10.1177/0954411916647078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/05/2016] [Indexed: 11/15/2022]
Abstract
Treatment of periprosthetic femur fractures after total hip arthroplasty remains a major challenge in orthopedic surgery. Recently, a novel surgical technique using intraprosthetic screw fixation has been suggested. The purpose of this study was to evaluate the influence of drilling the femoral hip stem on integrity and strength of the implant. The hypothesis was that intraprosthetic drilling and screw fixation would not cause the load limit of the prosthesis to be exceeded and that deformation would remain within the elastic limit. A sawbone model with a conventional straight hip stem was used and a Vancouver C periprosthetic fracture was created. The fracture was fixed with a nine-hole less invasive stabilization system plate with two screws drilled and inserted through the femoral hip stem. Three different finite element models were created using ANSYS software. The models increased in complexity including joint forces and stress risers from three different dimensions. A variation of drilling positions was analyzed. Due to the complexity of the physiological conditions in the human femur, the most complex finite element model provided the most realistic results. Overall, significant changes in the stresses to the prosthesis caused by the drilling procedure were observed. While the stresses at the site of the bore hole decreased, the load increased in the surrounding stem material. This effect is more pronounced and further the holes were apart, and it was found that increasing the number of holes could counteract this. The maximum load was still found to be in the area of the prosthesis neck. No stresses above the load limit of titanium alloy were detected. All deformations of the prosthesis stem remained in the elastic range. These results may indicate a potential role for intraprosthetic screw fixation in the future treatment of periprosthetic femur fractures.
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Affiliation(s)
- Stephan Brand
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Michael Bauer
- Institute of Materials Science, Leibniz University of Hannover, Hannover, Germany
| | - Maximilian Petri
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Julian Schrader
- Institute of Materials Science, Leibniz University of Hannover, Hannover, Germany
| | - Hans J Maier
- Institute of Materials Science, Leibniz University of Hannover, Hannover, Germany
| | | | - Thomas Hassel
- Institute of Materials Science, Leibniz University of Hannover, Hannover, Germany
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Joestl J, Hofbauer M, Lang N, Tiefenboeck T, Hajdu S. Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty. Injury 2016; 47:939-43. [PMID: 26872997 DOI: 10.1016/j.injury.2016.01.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Revision arthroplasty is currently the recommended treatment for periprosthetic femoral fractures after primary total hip arthroplasty (THA) and stem loosening (Vancouver B2). However, open reduction and internal fixation (ORIF) utilizing locking compression plate (LCP) might be an effective treatment with a reduced surgical time and less complex procedure in a typically elderly patient collective with multiple comorbidities. The purpose of this study was to compare the functional and radiographic outcomes in two cohorts with Vancouver B2 periprosthetic femoral fractures after primary THA, treated either by ORIF with LCP fixation, or by revision arthroplasty utilizing a non-cemented long femoral stem. MATERIALS AND METHODS 36 patients with Vancouver B2 periprosthetic femoral fractures following THA, who had been treated between 2000 and 2014, were reviewed. Eight fractures were treated with LCP fixation, fourteen fractures with the first-generation revision prosthesis (Helios), and fourteen fractures with the second-generation revision prosthesis (Hyperion). The patients were assessed clinically with the Parker mobility score and radiographically. RESULTS A total of ten males and 26 females formed the basis of this report with an average age of 81 years (range, 64 to 96 years). All fractures treated with LCP fixation alone healed uneventfully and there were no signs of secondary stem migration, malalignement or plate breakage. The average surgical time was shorter in the ORIF cohort; however, the results were not statistically significant. The postoperative Parker mobility score at latest follow-up showed no difference between the groups. CONCLUSIONS According to the results of the current study, we conclude that the use of LCP fixation can be a sufficient option for the treatment of Vancouver B2 periprosthetic femoral fractures correspondingly with femoral stem loosening.
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Affiliation(s)
- Julian Joestl
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | - Marcus Hofbauer
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Nikolaus Lang
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Thomas Tiefenboeck
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Stefan Hajdu
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Stoffel K, Sommer C, Kalampoki V, Blumenthal A, Joeris A. The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases. Arch Orthop Trauma Surg 2016; 136:553-61. [PMID: 26781127 DOI: 10.1007/s00402-016-2407-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A systematic literature review on periprosthetic/interprosthetic fracture fixation after hip arthroplasties was performed to summarize available clinical data. Operation techniques and implants used were evaluated as possible risk factors for outcomes. MATERIALS AND METHODS MEDLINE and Cochrane databases were searched. Articles describing patients with postoperative periprosthetic femur fractures sustained around a hip arthroplasty and with interprosthetic fractures treated with plates, nails, screws and/or cerclage were included. Considered articles were from 2000 or newer. Eligible abstracts were screened by two independent persons and discrepancies were resolved by consensus. Absolute numbers of complications and/or reoperation events along with their corresponding rates were calculated according to operation technique and type of implant. Relative risks of having a complication and/or a reoperation according to the operation technique and the type of implant used were estimated. RESULTS Available data from 49 prospective and retrospective studies were analyzed. Of 1574 fractures, 81.7 % were treated with plating. For 83.0 % of all fractures, an open approach was applied. The overall complication rate was 14.3 %. Fixation failure and nonunion were most often reported (fixation failure: 4.4 %; nonunion: 3.9 %). Nonunion and refracture occurred more often after open approaches than after minimal invasive osteosynthesis (nonunion: 4.5 vs. 0.0 %, p = 0.001; refracture: 3.8 vs. 0.6 %. p = 0.024). The relative risk for nonunion was 11.9 (95 % CI 4.5-31.5) times higher (p < 0.0001) for non-locking plates (13.0 %) than for locking plates (1.1 %). CONCLUSIONS The clinical evidence of published studies dealing with periprosthetic/interprosthetic fractures after hip arthroplasty is generally low. This literature search suggested higher rates of nonunion and refracture after an open approach and a higher risk of nonunion for non-locking plates compared to locking plates. Based on the available clinical evidence, no treatment recommendations can be given.
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Affiliation(s)
- Karl Stoffel
- Department of Orthopedics and Traumatology, University of Basel and Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
| | - Christoph Sommer
- Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
| | - Vasiliki Kalampoki
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
| | - Andrea Blumenthal
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
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Brand S, Ettinger M, Omar M, Hawi N, Krettek C, Petri M. Concepts and Potential Future Developments for Treatment of Periprosthetic Proximal Femoral Fractures. Open Orthop J 2015; 9:405-11. [PMID: 26401164 PMCID: PMC4578140 DOI: 10.2174/1874325001509010405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/08/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022] Open
Abstract
Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies.
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Affiliation(s)
| | - Max Ettinger
- Orthopaedic Department, Hannover Medical School, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Germany
| | - Nael Hawi
- Trauma Department, Hannover Medical School, Germany
| | | | - Maximilian Petri
- Trauma Department, Hannover Medical School, Germany ; Steadman Philippon Research Institute, Vail, CO, USA
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Boesmueller S, Baumbach SF, Hofbauer M, Wozasek GE. Plate failure following plate osteosynthesis in periprosthetic femoral fractures. Wien Klin Wochenschr 2015; 127:770-8. [PMID: 26187336 DOI: 10.1007/s00508-015-0818-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing numbers of total knee and hip arthroplasties result in a growing number of periprosthetic femoral fractures (PPFF). PPFF with a stable stem component are treated commonly with plate osteosynthesis. Therefore plate failure is seen as a major complication. The aim of this retrospective study was to investigate the patients' outcome after plate failure. METHODS The database of a Level 1 trauma center was searched for all patients treated for a PPFF with plate osteosynthesis. Patients with plate failure were investigated specifically. Standard demographic data, details on initial arthroplasty, trauma, and treatment were recorded for all patients. All fractures were classified and their outcome reviewed. RESULTS Seven (8.8%) out of 80 patients treated with plate osteosynthesis following PPFF met our inclusion criterion being plate failure. All these patients were female, with an average age at primary surgery of 74 ± 13 years and a mean follow-up of 885 days (range, 264-2549). Four patients suffered a PPFF after total hip arthroplasty (THA) (2 Vancouver Type B1 and 2 Type C) and three after total knee arthroplasty (TKA) (Lewis-Rorabeck Type II). Following plate failure, four patients healed uneventfully and three patients experienced complications such as pseudarthrosis, screw loosening, and further plate failure. CONCLUSION In patients with poor bone quality, bone graft, bone cement, and bone biologics have to be considered in revision surgery. Furthermore, long-stem revision and tumor prosthesis are an additional solution.
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Affiliation(s)
- Sandra Boesmueller
- Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Sebastian F Baumbach
- Department of Trauma Surgery-Campus Innenstadt, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marcus Hofbauer
- Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerald E Wozasek
- Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Treatment of type B periprosthetic femur fractures with curved non-locking plate with eccentric holes: Retrospective study of 43 patients with minimum 1-year follow-up. Orthop Traumatol Surg Res 2015; 101:277-82. [PMID: 25817903 DOI: 10.1016/j.otsr.2015.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/29/2014] [Accepted: 01/16/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Periprosthetic femur fracture (PFF) is a serious complication after total hip arthroplasty that can be treated using different internal fixation devices. However, the outcomes with curved non-locking plates with eccentric holes in this indication have not been reported previously. The objectives of this study were to determine: (1) the union rate; (2) the complication rate; (3) autonomy in a group of patients with a Vancouver type B PFF who were treated with this plate. HYPOTHESIS Use of this plate results in a high union rate with minimal mechanical complications. MATERIALS AND METHODS Forty-three patients with a mean age of 79 years ± 13 (41-98) who had undergone fixation of Vancouver type B PFF with this plate between 2002 and 2007 were included in the study. The time to union and Parker Mobility Score were evaluated. The revision-free survival (all causes) was calculated using Kaplan-Meier analysis. The average follow-up was 42 months ± 20 (16-90). RESULTS Union was obtained in all patients in a mean of 2.4 months ± 0.6 (2-4). One patient had varus malunion of the femur. The Parker Mobility Score decreased from 5.93 ± 1.94 (2-9) to 4.93 ± 1.8 (1-9) (P = 0.01). Two patients required a surgical revision: one for an infection after 4.5 years and one for stem loosening. The survival of the femoral stem 5 years after fracture fixation was 83.3% ± 12.6%. CONCLUSION Use of a curved plate with eccentric holes for treating type B PFF led to a high union rate and a low number of fixation-related complications. However, PFF remains a serious complication of hip arthroplasty that is accompanied by high morbidity and mortality rates.
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Retrograde intramedullary nailing with a blocking pin technique for reduction of periprosthetic supracondylar femoral fracture after total knee arthroplasty: technical note with a compatibility chart of the nail to femoral component. Case Rep Orthop 2014; 2014:856853. [PMID: 25574411 PMCID: PMC4276684 DOI: 10.1155/2014/856853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/23/2014] [Indexed: 11/25/2022] Open
Abstract
Periprosthetic fractures after total knee arthroplasty (TKA) present a clear management challenge, and retrograde intramedullary nails have recently gained widespread acceptance in treatment of these fractures. In two cases, we found a blocking screw technique, first reported by Krettek et al., was useful in the reduction of the fractures. Both patients attained preinjury mobility after intramedullary nailing. Moreover, we present a chart summarizing the notch designs of various femoral components because some prosthetic knee designs are not amenable to retrograde nailing. We hope this will be helpful in determining indications for retrograde nailing in periprosthetic fractures after TKA.
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Abstract
OBJECTIVES Vancouver type B1 periprosthetic femur fractures occur around a stable implant and are typically treated with open reduction and internal fixation (ORIF). Different fixation techniques are described in the literature, and there is a lack of consensus regarding the best operative fixation strategy. The purpose of this investigation was to systematically review and compare the most commonly used fixation strategies for these fractures. DATA SOURCES A database search was performed using PubMed, MEDLINE, and Cochrane databases to identify studies published in English language from 1985 to 2013. STUDY SELECTION Articles with a minimum of 5 patients with type B1 periprosthetic femur fractures and containing outcome data regarding nonunion, malunion, infection, and reoperation rate were included. DATA EXTRACTION Studies were analyzed and categorized into 4 groups: group 1: ORIF with cortical strut allografts alone, group 2: ORIF with cable plate/compression plates alone, group 3: ORIF with cable plate/compression plates and cortical strut allograft, group 4: ORIF with locking plates alone. Individual patient outcomes were extracted for each study and pooled for each of the 4 groups. Data analysis was performed comparing rates of nonunion, malunion, hardware failure, infection, and reoperation. DATA SYNTHESIS Data were analyzed using Review Manager and SAS 9.3. CONCLUSIONS In total, 333 patients identified with an overall rate of 5% nonunion, 6% malunion, 5% infection, 4% hardware failure, 9% reoperation, and 15% total complications. When comparing outcomes for different modes of fixation, compared with cable plate/compression plate systems, locking plates had a significantly higher rate of nonunion (3% vs. 9% P = 0.02) and a trend toward a higher rate of hardware failure (2% vs. 7%, P = 0.07). There are limitations to this study, and further investigation with high-quality randomized controlled trials is needed to effectively compare treatment strategies.
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Clinical and radiological results of locking plate fixation for periprosthetic femoral fractures around hip arthroplasties: a retrospective multi-center study. J Orthop Sci 2014; 19:984-90. [PMID: 25145998 DOI: 10.1007/s00776-014-0622-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Osteosynthesis of periprosthetic femoral fractures around hip arthroplasties is challenging, and locking plate fixation has been found to be a reasonable treatment. However, there is a paucity of evidence of the extent to which patients recover their activities of daily living (ADL). The purpose of this study was to study the clinical results, particularly recovery of ADL, radiological results, and potential complications arising from the use of locking plate fixation for periprosthetic femoral fractures around hip arthroplasties. METHODS We conducted a retrospective, multi-center study. Patients with periprosthetic femoral fractures around hip arthroplasties who were treated by osteosynthesis with use of locking plates and who underwent follow-up for at least 6 months postoperatively were enrolled in the study. For each patient, recovery of ADL, in terms of social and ambulatory recovery and Parker mobility score, were compared before fracture and at last follow-up. Postoperative complications were investigated. Bony union, loss of reduction, and malunion were assessed radiologically. RESULTS Thirty-two patients were enrolled in this study. Mean follow-up was 25.1 months. For 84.4, 68.8, and 53.1% of patients, respectively, social status, ambulation, and Parker mobility score at last follow-up were determined to be equal to that before the fracture. Bony union was observed for 30 patients within the follow-up period. Four patients had not achieved bony union 6 months postoperatively. There was no loss of reduction, malunion, or implant breakage, and no infection. For one patient each, partial pullout of the locking screws and a supracondylar fracture at the plate end were observed, and additional surgery was required. CONCLUSIONS Our results reveal that locking plate fixation provided sufficient stability for satisfactory recovery of ADL for most elderly patients with periprosthetic femoral fractures around hip arthroplasties.
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Niikura T, Lee SY, Sakai Y, Nishida K, Kuroda R, Kurosaka M. Treatment results of a periprosthetic femoral fracture case series: treatment method for Vancouver type b2 fractures can be customized. Clin Orthop Surg 2014; 6:138-45. [PMID: 24900893 PMCID: PMC4040372 DOI: 10.4055/cios.2014.6.2.138] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 08/04/2013] [Indexed: 11/24/2022] Open
Abstract
Background Currently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon's experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series. Methods Eighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon's judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated. Results Thirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities. Conclusions We suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient's hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.
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Affiliation(s)
- Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sang Yang Lee
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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A systematic review of open reduction and internal fixation of periprosthetic femur fractures with or without allograft strut, cerclage, and locked plates. J Arthroplasty 2014; 29:872-6. [PMID: 24650900 DOI: 10.1016/j.arth.2012.12.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 12/16/2012] [Accepted: 12/18/2012] [Indexed: 02/01/2023] Open
Abstract
Few comparative studies exist for open reduction and internal fixation of Vancouver B1 and C fractures. We therefore performed a systematic review of fractures treated with or without an allograft strut, and using various fixation techniques. Thirty-seven manuscripts including 682 fractures were identified between 1992 and 2012. Percent union was similar for Vancouver B1 fractures treated with or without an allograft strut (90.7% vs. 91.5%). Time to union (4.4 vs. 6.6 months) and deep infection (3.8% vs. 8.3%) were increased with use of allograft struts. Percent union and time to union were unaffected by plate type or use of cerclage. We conclude that due to increased infection and time to union, allograft struts should be used cautiously during operative treatment of Vancouver B1 factures.
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Abstract
PURPOSE To evaluate outcome in 20 patients treated for periprosthetic fractures after total knee arthroplasty (TKA). METHODS Records of 14 women and 6 men aged 45 to 85 (mean, 67) years who underwent operative (n=18) or conservative (n=2) treatment for periprosthetic fractures of the supracondylar femur (n=15), patella (n=3), and tibia (n=2) following minor falls (n=18) or high-velocity injury (n=2) were reviewed. The mean time from TKA to fracture was 43 (range, 14-98) months. Of the 15 supracondylar femoral fractures, 2 were managed with immobilisation in a long leg cast, 11 with internal fixation using locked compression plating, and 2 with revision arthroplasty. All 3 patellar fractures were managed with tension band wiring. Both tibial fractures were managed with revision arthroplasty. Radiographic and functional outcomes (the Knee Society scores) were assessed. RESULTS The mean follow-up was 35 (range, 24-48) months. All fractures healed after a mean of 15 (range, 12-38) weeks. One patient had delayed union. Postoperative alignment was satisfactory in all patients except one (with 5º varus). The mean tibiofemoral angle was 4º valgus. The mean range of motion was 98.5º. The mean Knee Society knee score was 85 (range, 75-89) and the functional score was 76 (range, 70-85). No patient had implant failure, loss of reduction, deep infection, deep vein thrombosis, or pulmonary embolism. CONCLUSION The locked compression plate is effective in managing periprosthetic femoral fractures. Periprosthetic patellar and tibial fractures are uncommon. The latter often warrant revision arthroplasty owing to the loose implant.
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Affiliation(s)
- Saurabh Agarwal
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
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18
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Brand S, Klotz J, Hassel T, Petri M, Ettinger M, Bach FW, Krettek C, Gösling T. Intraprosthetic screw fixation increases primary fixation stability in periprosthetic fractures of the femur—A biomechanical study. Med Eng Phys 2014; 36:239-43. [DOI: 10.1016/j.medengphy.2013.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 07/17/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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Chen AF, Choi LE, Colman MW, Goodman MA, Crossett LS, Tarkin IS, McGough RL. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures. J Arthroplasty 2013; 28:1580-4. [PMID: 23540541 DOI: 10.1016/j.arth.2013.02.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/14/2013] [Accepted: 02/21/2013] [Indexed: 02/01/2023] Open
Abstract
Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpose of this study is to compare patients who failed plating techniques requiring subsequent revision to DFA to patients who underwent primary DFA. Of the 13 patients (9.2%) who failed primary ORIF, causes included nonunion (53.8%), infection (30.8%), loosening (7.7%), and refracture (7.7%). There were significantly more surgical procedures for ORIF revision to DFA compared to primary DFA. Complications for patients who underwent primary reconstruction with DFAs included extensor mechanism disruption (8.3%), infection (5.6%), and dislocation (2.8%). Primary reconstruction via ORIF is beneficial for preserving bone stock, but primary DFA may be preferred in osteopenic patients, or those at high risk for nonunion.
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Affiliation(s)
- Antonia F Chen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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20
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[Periprosthetic humeral fracture: complex circumstances need critical selection of therapy]. DER ORTHOPADE 2013; 42:654-7. [PMID: 23881166 DOI: 10.1007/s00132-013-2151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although periprosthetic humeral fractures were previously rare injuries, they will increase because of the rising life expectancy of patients and increasing implantation of shoulder prostheses. This article describes a case of an 86-year-old female patient with very thin humeral cortex and a prosthesis filling the medullary cavity. The morphology of fractures and the surrounding circumstances determine choice of therapy.
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Graham SM, Moazen M, Leonidou A, Tsiridis E. Locking plate fixation for Vancouver B1 periprosthetic femoral fractures: a critical analysis of 135 cases. J Orthop Sci 2013; 18:426-36. [PMID: 23420340 DOI: 10.1007/s00776-013-0359-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/17/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The overall incidence of periprosthetic femoral fractures (PPF) is between 0.1 and 6 % of all total hip arthroplasties. Locking compression plates (LCP) have been used for the treatment of Vancouver B1 PPFs with variable results. The aim of this study is to examine the literature on locking plate failure rates, mode and reasons for failure. METHODOLOGY A literature search was conducted for studies reporting the management of PPF of the femur with LCP fixation. The primary medical search engines used for the study were Ovid MEDLINE and EMBASE databases up to August 2012. RESULTS Twelve studies were identified, reporting overall union rates of 91 % in 135 fractures. Only 7 (5 %) fractures required revision surgery due to plate fracture (5) or pull out (2). Important trends in plate complications included: stress riser at the end of the plate, stress concentration in the fracture area due to rigid fixation, early loading and absence of cortical strut grafting for biological support when needed. CONCLUSION LCP has been used successfully in the management of Vancouver B1 PPF. However, potential areas of improvement include, leaving the fracture site free of locking screws, therefore, not disturbing the soft tissue envelope around the fracture and also reducing plate stiffness. Adding cortical strut allografts to improve stability and bone quality, if needed, may also improve outcome. Limitations in the use of strut grafts or transverse fractures below the tip of the stem that cannot be controlled with single or double plating may require long stem revision to achieve axial stability.
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Affiliation(s)
- Simon M Graham
- Royal Liverpool and Broadgreen University Hospital, Orthopaedics, Liverpool, UK.
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Wang JQ, Gao YS, Mei J, Rao ZT, Wang SQ. Revision hip arthroplasty as a treatment of Vancouver B3 periprosthetic femoral fractures without bone grafting. Indian J Orthop 2013; 47:449-53. [PMID: 24133303 PMCID: PMC3796916 DOI: 10.4103/0019-5413.118199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND It is conventionally considered that bone grafting is mandatory for Vancouver B3 periprosthetic femoral fractures (PFF) although few clinical studies have challenged the concept previously. The aim of the current study was to investigate the radiographic and functional results of Vancouver B3 PFF treated by revision total hip or hemiarthroplasty (HA) in combination with appropriate internal fixation without bone grafting. MATERIALS AND METHODS 12 patients with Vancouver B3 PFF were treated by revision THA/HA without bone grafting between March 2004 and May 2008. There were nine females and three males, with an average age of 76 years. PFFs were following primary THA/HA in nine patients and following revision THA/HA in three. Postoperative followup was 5.5 years on average (range, 3.5-6.5 years). At the final followup, radiographic results were evaluated with Beals and Tower's criteria and functional outcomes were evaluated using the Merle d'Aubigné scoring system. RESULTS All fractures healed within an average of 20 weeks (range, 12-28 weeks). There was no significant deformity and shortening of the affected limb and the implant was stable. The average Merle d'Aubigné score was 15.8. Walking ability was regained in 10 patients without additional assistance, while 2 patients had to use crutches. There were 2 patients with numbness of lateral thigh, possibly due to injury to the lateral femoral cutaneous nerve. There were no implant failures, dislocation and refractures. CONCLUSIONS Revision THA/HA in combination with appropriate internal fixation without bone grafting is a good option for treatment of Vancouver B3 periprosthetic femoral fractures in the elderly.
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Affiliation(s)
- Jia-Qi Wang
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University, Shanghai 200065, China
| | - You-Shui Gao
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China,Address for correspondence: Dr. You-Shui Gao, Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China. E-mail:
| | - Jiong Mei
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University, Shanghai 200065, China
| | - Zhi-Tao Rao
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University, Shanghai 200065, China
| | - Shu-Qing Wang
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University, Shanghai 200065, China
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El-Zayat BF, Ruchholtz S, Efe T, Paletta J, Kreslo D, Zettl R. Results of titanium locking plate and stainless steel cerclage wire combination in femoral fractures. Indian J Orthop 2013; 47:454-8. [PMID: 24133304 PMCID: PMC3796917 DOI: 10.4103/0019-5413.118200] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Some in vitro studies warn combining different metals in orthopedic surgery. The aim of this study is to determine the impact of combining titanium and stainless steel on bone healing and the clinical course of patients undergoing internal fixation of femoral fractures. MATERIALS AND METHODS 69 patients with femoral fractures had polyaxial locking plate osteosynthesis. The locking plate was made of a titanium alloy. Two different cohorts were defined: (a) sole plating and (b) additional stainless steel cerclage wiring. Postoperative radiographs and clinical followup were performed at 6 weeks, 3 months and 12 months. RESULTS Cohorts A and B had 36 and 33 patients, respectively. Patient demographics and comorbidities were similar in both groups. In two cases in cohort A, surgical revision was necessary. No complication could be attributed to the combination of titanium and stainless steel. CONCLUSION The combination of stainless steel cerclage wires and titanium plates does not compromise fracture healing or the postoperative clinical course.
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Affiliation(s)
- Bilal Farouk El-Zayat
- Department of Orthopaedics, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstrasse, 35033 Marburg, Germany,Address for correspondence: Dr. Bilal Farouk El-Zayat, Department of Orthopaedics, University Hospital Marburg, Baldingerstrasse - 35043 Marburg, Germany. E-mail: marburg.de
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstrasse, 35033 Marburg, Germany
| | - Turgay Efe
- Department of Orthopaedics, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstrasse, 35033 Marburg, Germany
| | - Jürgen Paletta
- Department of Orthopaedics, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstrasse, 35033 Marburg, Germany
| | - Dimitri Kreslo
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstrasse, 35033 Marburg, Germany
| | - Ralph Zettl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstrasse, 35033 Marburg, Germany
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[Minimally invasive treatment of geriatric and osteoporotic femur fractures with polyaxial locking implants (NCB-DF®)]. Unfallchirurg 2012; 115:134-44. [PMID: 21082161 DOI: 10.1007/s00113-010-1871-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Periprosthetic femur fractures in elderly patients are a challenging surgical procedure. The aim of this study was a prospective evaluation of minimally invasive implantation of non-contact bridging (NCB-DF®) plates. PATIENTS AND METHODS A total of 30 osteosynthesis procedures in 29 patients (average age 76 years and mean ASA 2.9) with complex femur fractures were registered, 19 fractures were periprosthetic and osteoporosis was present in 17 bones. In 25 patients a minimally invasive percutaneous procedure was performed using a standardized technique. An x-ray examination and clinical follow-up were performed after 6, 12 and 24 weeks. RESULTS The early complications (14% in total) included 1 plate breakage after 16 weeks as well as 3 minor revisions for screw length correction. The x-ray follow-up after 24 weeks showed a secondary extension deficit of 10° and 15° in the knee joint in 2 patients, respectively. CONCLUSION The NCB-DF® implantation using a standardized minimally invasive technique in periprosthetic femur fractures is a safe alternative in elderly patients. In this very sensitive population the early revision rate within the first 24 weeks is noticeable lower compared to similar procedures.
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El-Zayat BF, Ruchholtz S, Efe T, Fuchs-Winkelmann S, Krüger A, Kreslo D, Zettl R. NCB-plating in the treatment of geriatric and periprosthetic femoral fractures. Orthop Traumatol Surg Res 2012; 98:765-72. [PMID: 23098773 DOI: 10.1016/j.otsr.2012.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 04/05/2012] [Accepted: 05/07/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study is the presentation of the polyaxial locking NCB-plate in the treatment of femoral fractures, especially in elderly patients and in proximity of a prosthetic implant. The reduction and fixation of these fractures is a challenging surgical procedure with high complication rates reported up to 40%. PATIENTS AND METHODS A total of 72 patients with femoral fractures had polyaxial locking plate osteosynthesis. Indications included fractures of the shaft and around an implant. Concerning surgical procedures, three different standardized techniques were performed: (1) minimally invasive with percutaneous distal insertion using a targeting device; (2) mini-open with additional cerclage wire via the same approach and (3) a conventional open reduction and internal fixation. Data collection included intraoperative data and early complications at 6, 24 and 52 weeks. Fifty-two patients had an implant or prosthesis in situ. Thirty-three patients were treated by technique (1), 32 patients had mini-open surgery and seven patients conventional open surgery. RESULTS Thirty-nine patients attended clinical follow-up after 52 weeks. Twenty-two patients were interviewed by telephone, two were untraceable and nine patients had died. Bony consolidation without secondary loss of reduction was confirmed after 52 weeks in all patients but two. Plate breakage occurred in these two at 25 and 31 weeks after surgery due to non-union. Implant related complications (17% in total) lead to surgical revision in five other cases: two deep wound infections as well as three minor revisions. When itemizing complications according to surgical technique used, most major complications occurred following open surgery. CONCLUSION The availability of polyaxial locking implants widened the range of indications for plate fixation in femoral fractures. The advantages of the polyaxial locking implant combined with minimally invasive surgical technique contribute to successful management of this population category. Early revision rate is noticeably lower compared to similar procedures. LEVEL OF EVIDENCE IV retrospective series.
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Affiliation(s)
- B F El-Zayat
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043 Marburg, Germany.
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Brand S, Klotz J, Hassel T, Petri M, Haasper C, Bach FW, Krettek C, Goesling T. Intraprosthetic fixation techniques in the treatment of periprosthetic fractures-A biomechanical study. World J Orthop 2012; 3:162-6. [PMID: 23326763 PMCID: PMC3536858 DOI: 10.5312/wjo.v3.i10.162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/25/2012] [Accepted: 10/10/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop new fixation techniques for the treatment of periprosthetic fractures using intraprosthetic screw fixation with inserted threaded liners.
METHODS: A Vancouver B1 periprosthetic fracture was simulated in femur prosthesis constructs using sawbones and cemented regular straight hip stems. Fixation was then performed with either unicortical locked-screw plating using the less invasive stabilization system-plate or with intraprosthetic screw fixation using inserted liners. Two experimental groups were formed using either prostheses made of titanium alloy or prostheses made of cobalt chrome alloy. Fixation stability was compared in an axial load-to-failure model. Drilling was performed using a specially invented prosthesis drill with constantly applied internal cooling.
RESULTS: The intraprosthetic fixation model with titanium prostheses was superior to the unicortical locked-screw fixation in all tested devices. The intraprosthetic fixation model required 10 456 N ± 1892 N for failure and the unicortical locked-screw plating required 7649 N ± 653 N (P < 0.05). There was no significant difference between the second experimental group and the control group.
CONCLUSION: Intraprosthetic screw anchorage with special threaded liners enhances the primary stability in treating periprosthetic fractures by internal fixation.
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Angulated locking plate in periprosthetic proximal femur fractures: biomechanical testing of a new prototype plate. Arch Orthop Trauma Surg 2012; 132:1437-44. [PMID: 22707211 DOI: 10.1007/s00402-012-1556-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Indexed: 02/09/2023]
Abstract
INTRODUCTION To improve proximal plate fixation of periprosthetic femur fractures, a prototype locking plate with proximal posterior angulated screw positioning was developed and biomechanically tested. METHODS Twelve fresh frozen, bone mineral density matched human femora, instrumented with cemented hip endoprosthesis were osteotomized simulating a Vancouver B1 fracture. Specimens were fixed proximally with monocortical (LCP) or angulated bicortical (A-LCP) head-locking screws. Biomechanical testing comprised quasi-static axial bending and torsion and cyclic axial loading until catastrophic failure with motion tracking. RESULTS Axial bending and torsional stiffness of the A-LCP construct were (1,633 N/mm ± 548 standard deviation (SD); 0.75 Nm/deg ± 0.23 SD) at the beginning and (1,368 N/mm ± 650 SD; 0.67 Nm/deg ± 0.25 SD) after 10,000 cycles compared to the LCP construct (1,402 N/mm ± 272 SD; 0.54 Nm/deg ± 0.19 SD) at the beginning and (1,029 N/mm ± 387 SD; 0.45 Nm/deg ± 0.15) after 10,000 cycles. Relative movements for medial bending and axial translation differed significantly between the constructs after 5,000 cycles (A-LCP 2.09° ± 0.57 SD; LCP 5.02° ± 4.04 SD; p = 0.02; A-LCP 1.25 mm ± 0.33 SD; LCP 2.81 mm ± 2.32 SD; p = 0.02) and after 15,000 cycles (A-LCP 2.96° ± 0.70; LCP 6.52° ± 2.31; p = 0.01; A-LCP 1.68 mm ± 0.32; LCP 3.14 mm ± 0.68; p = 0.01). Cycles to failure (criterion 2 mm axial translation) differed significantly between A-LCP (15,500 ± 2,828 SD) and LCP construct (5,417 ± 7,236 SD), p = 0.03. CONCLUSION Bicortical angulated screw positioning showed less interfragmentary osteotomy movement and improves osteosynthesis in periprosthetic fractures.
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Periprosthetic fractures in the distal femur following total knee replacement: A review and guide to management. Knee 2012; 19:156-62. [PMID: 21741844 DOI: 10.1016/j.knee.2011.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 06/03/2011] [Accepted: 06/06/2011] [Indexed: 02/02/2023]
Abstract
The management of distal femoral fractures following a total knee replacement can be complex and requires the equipment, perioperative support and surgical skills of both trauma and revision arthroplasty services. Recent advances in implant technology have changed the management options of these difficult fractures. This article describes the options available and discusses the latest evidence.
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The locking attachment plate for proximal fixation of periprosthetic femur fractures--a biomechanical comparison of two techniques. INTERNATIONAL ORTHOPAEDICS 2012; 36:1915-21. [PMID: 22638607 DOI: 10.1007/s00264-012-1574-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Mechanical properties of a locking attachment plate construct (LAP-LCP), allowing bicortical screw placement laterally to the prosthesis stem, are compared to a cerclage-LCP construct. METHODS Eight right synthetic femora with implanted uncemented hip endoprosthesis were cut distally and fixed with LCP, monocortical locking screws and either LAP (n = 4) or cerclage (n = 4). Cyclic testing was performed with monotonically increasing sinusoidal load until failure. Relative movements at the plate-femur interface were registered by motion tracking. Statistical differences were detected by unpaired t-test and general linear model repeated measures. RESULTS Stiffness of the LAP-LCP was significantly higher at the beginning (875.4 N/mm ± 29.8) and after 5000 cycles (1213.0 N/mm ± 101.1) compared to the cerclage-LCP (644.96 N/mm ± 50.1 and 851.9 N/mm ± 81.9), with p = 0.013. Relative movements for AP-bending (B) and axial translation (T) of the LAP-LCP at the beginning (0.07° ± 0.02, 0.20 mm ± 0.08), after 500 cycles (0.16° ± 0.10, 0.26 mm ± 0.07) and after 5000 cycles (0.26° ± 0.11, 0.31 mm ± 0.07) differed significantly from the cerclage-LCP (beg.: 0.26° ± 0.04, 0.28 mm ± 0.05; 500 cyc: 0.47° ± 0.03, 0.53 mm ± 0.07; 5000 cyc.: 0.63° ± 0.18, 0.79 mm ± 0.13), with B: p = 0.02, T: p = 0.04. Relative movements for medial bending were not significantly different between the two constructs. Cycles to failure (criterion 1 mm axial translation) differed significantly between LAP-LCP (19,519 ± 1,758) and cerclage-LCP (11,265 ± 2,472), with p = 0.035. CONCLUSIONS Biomechanically, the LAP-LCP construct improves proximal fixation of periprosthetic fractures compared to the cerclage-LCP construct.
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Aggressive surgical treatment of periprosthetic femur fractures can reduce mortality: comparison of open reduction and internal fixation versus a modular prosthesis nail. J Orthop Trauma 2012; 26:80-5. [PMID: 21926637 DOI: 10.1097/bot.0b013e31821d6f55] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to determine if immediate full weightbearing after surgical treatment for periprosthetic femur fractures can decrease perioperative and total mortality. DESIGN Retrospective review. SETTING Level II trauma center. PATIENTS Fifty-two consecutive patients with a periprosthetic femur fracture during a 16-year time period. INTERVENTION Comparison of open reduction and internal fixation with a plate (non- or partial postoperative weightbearing) versus stem exchange to a modular prosthesis nail (immediate full postoperative weightbearing). MAIN OUTCOME MEASUREMENTS Six-month and total mortality using a Kaplan-Meier survival analysis. An additional matched subanalysis was performed for Vancouver Type B1 fractures. RESULTS Patients permitted immediate postoperative full weightbearing had a significantly decreased total (P < 0.001) and 6-month mortality (P = 0.007). Subanalysis of patients with Vancouver Type B1 fractures also showed decrease in mortality, which was significant for total (P < 0.005) but not for 6-month mortality (P = 0.121). CONCLUSION Treatment of periprosthetic femur fractures with femoral component exchange to a modular prosthetic nail that allows immediate postoperative full weightbearing may decrease mortality.
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Fitzpatrick N, Nikolaou C, Yeadon R, Hamilton M. String-Of-Pearls Locking Plate and Cerclage Wire Stabilization of Periprosthetic Femoral Fractures after Total Hip Replacement in Six Dogs. Vet Surg 2011; 41:180-8. [DOI: 10.1111/j.1532-950x.2011.00870.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ehlinger M, Adam P, Abane L, Rahme M, Moor BK, Arlettaz Y, Bonnomet F. Treatment of periprosthetic femoral fractures of the knee. Knee Surg Sports Traumatol Arthrosc 2011; 19:1473-8. [PMID: 21431372 DOI: 10.1007/s00167-011-1480-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE We report a continuous series of periprosthetic femoral fractures after knee arthroplasty treated with a locking plate. We hypothesize that minimally invasive surgery and immediate weight-bearing improve functional recovery. METHODS From June 2002 to December 2008, 15 patients with 16 fractures were treated. Median age was 81 years. The autonomy level according to the mobility score of Parker and Palmer showed a median of 5 (0-9). Osteosynthesis was performed mainly through a minimally invasive approach using a locking compression plate. The rehabilitation protocol consisted of immediate mobilization and, whenever possible, immediate unrestricted weight-bearing. RESULTS Five patients died during follow-up, more than 1 year after osteosynthesis. Their results were included. Autonomy and mobility were preserved with a median postoperative score of 4 (0-9) according to Parker and Palmer. The consolidation rate was 93.8%, which was obtained within 10 weeks. There were no mechanical or infectious complications. Fourteen cases were treated with minimally invasive surgery without fracture exposition; the remaining 2 required a slightly more extended approach. Full weight-bearing occurred 10 times; 20-kg partial weight-bearing was advised twice; and on 4 occasions, no weight-bearing was allowed for 6 weeks. CONCLUSION Osteosynthesis with a minimally invasive bridge-plating technique is effective in the treatment of periprosthetic, distal femoral fractures without component loosening. Immediate full weight-bearing is possible if certain rules are respected. The surgical management presented herein is beneficial for these challenging fractures, and it may help reduce the complication rate and improve functional outcome.
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Affiliation(s)
- Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg cedex, France.
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Nickel-titanium shape-memory sawtooth-arm embracing fixator for periprosthetic femoral fractures. INTERNATIONAL ORTHOPAEDICS 2011; 36:619-26. [PMID: 21805070 DOI: 10.1007/s00264-011-1325-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE We reviewed data to determine outcomes for 21 consecutive Vancouver type B1 or type C periprosthetic fractures that we treated between 2001 and 2008 using a nickel-titanium shape-memory sawtooth-arm embracing fixator. METHODS The study participants were 12 men and 9 women (mean age, 70.8 years; range, 42-85 years). The average duration of follow-up monitoring was 39.7 months (range, 1-78 months). In five cases, cables and screws were used for further stabilisation. No bone grafting was performed for any of the patients. RESULTS Results were satisfactory, except for one patient who died one month after surgery from a cause unrelated to arthroplasty. Bone union was achieved in the remaining 20 cases within an average of 5.25 months. No implant failures or malunions occurred in any of the patients. The average Harris hip score at the final follow-up examination was 79.3 points. CONCLUSIONS Our results show that the embracing fixator is a valid alternative treatment for Vancouver type B1 or type C periprosthetic femoral fractures.
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Outcome after operative treatment of Vancouver type B1 and C periprosthetic femoral fractures: open reduction and internal fixation versus revision arthroplasty. Arch Orthop Trauma Surg 2011; 131:983-9. [PMID: 21331551 DOI: 10.1007/s00402-011-1272-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The rate of periprosthetic femoral fractures after hip arthroplasty is rising and the estimated current lifetime incidence is 0.4-2.1%. While most authors recommend revision arthroplasty in patients with loose femoral shaft components, treatment options for patients with stable stem are not fully elucidated. METHOD Against this background we performed a retrospective chart analysis with clinical follow-up examination of 32 cases that sustained a Vancouver type B1 or C periprosthetic fracture (stable stem). PATIENTS Overall 16 cases were treated by open reduction and internal fixation (ORIF) by plate osteosynthesis and 16 cases by revision arthroplasty (RA). Both groups were comparable regarding age, gender, follow-up time interval, time interval from primary hip arthroplasty to fracture and rate of cemented femoral components, but more type C fractures were treated by ORIF. RESULTS Functional outcome expressed by the median timed "Up and Go" test did not differ significantly (30 s ORIF vs. 24 s RA, P = 0.19). However, by comparable systemic complications surgery-related complications were significantly more frequent in plate osteosynthesis (ORIF n = 10 vs. RA n = 3, P = 0.03). Based on our results, further studies, preferable via a multicenter approach, should focus on identifying patients that benefit from ORIF in periprosthetic fractures. A misinterpretation of type B2 fractures with loose implant as type B1 fractures may cause implant failure in case of ORIF. CONCLUSION The use of angular stable implants, additional cable wires or bone enhancing means is recommended.
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Baxter JA, Krkovic M, Prakash U. Intertrochanteric femoral fracture after hip resurfacing managed with a reverse distal femoral locking plate: a case report. Hip Int 2011; 20:562-4. [PMID: 21157767 DOI: 10.1177/112070001002000425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2010] [Indexed: 02/04/2023]
Abstract
Metal-on-metal hip resurfacing is a popular procedure for a select group of patients. A variety of surgical approaches are being utilised, each of which may be associated with specific complications. We describe an unusual complication following a Ganz trochanteric osteotomy approach, and the technique used to treat the subsequent periprosthetic fracture.
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Affiliation(s)
- Jonathan A Baxter
- Department of Trauma and Orthopaedic Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
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36
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[Periprosthetic fractures after total hip arthroplasty : classification, diagnosis and therapy strategies]. DER ORTHOPADE 2010; 39:519-35. [PMID: 20405105 DOI: 10.1007/s00132-010-1612-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The number of periprosthetic fractures following hip replacement is increasing due to longer life expectancy and the rising number of joint replacements. The main causes of periprosthetic fractures include trauma, implant specific factors or loosening of the endoprosthesis. When planning therapy, surgeons should consider specific and general implant- and patient-related risk factors to ensure the best possible treatment. Established classification systems can facilitate preoperative planning. At present, the Vancouver classification system probably comes closest to the ideal, as it considers fracture configuration, stability of the implant and quality of the bone stock. Depending on these factors, therapeutic options include conservative treatment, fracture stabilisation or replacement of the endoprosthesis. The problems associated with periprosthetic fractures of varying etiology and the available treatment options are discussed against the background of the established classification systems.
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Neubauer T, Wagner M. [Current status of minimally invasive plate osteosynthesis: specific part II]. Unfallchirurg 2010; 112:981-95; quiz 996. [PMID: 19851717 DOI: 10.1007/s00113-009-1703-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
With the increasing use of minimally invasive plate osteosynthesis in the last years almost every anatomical region was included in this new technique. Thus, it is not used any more for certain fractures and problematic areas, but also in fractures where it represents a challenge to established osteosynthesis techniques like intramedullary nailing or conventional plating. Therefore the challenge for the treating surgeon increased to find the right answer for the particularities of an individual fracture by choosing the optimal method. The most popular indications for the use of minimally invasive plate osteosynthesis are presented and the technical details are discussed. The possibilities for complications--in a common way and for specific fractures--are presented and discussed.
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Affiliation(s)
- T Neubauer
- Abteilung für Unfallchirurgie, Landesklinikum Waldviertel Horn, Spitalgasse 10, 3580 Horn.
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Streubel PN, Gardner MJ, Morshed S, Collinge CA, Gallagher B, Ricci WM. Are extreme distal periprosthetic supracondylar fractures of the femur too distal to fix using a lateral locked plate? ACTA ACUST UNITED AC 2010; 92:527-34. [PMID: 20357329 DOI: 10.1302/0301-620x.92b3.22996] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
It is unclear whether there is a limit to the amount of distal bone required to support fixation of supracondylar periprosthetic femoral fractures. This retrospective multicentre study evaluated lateral locked plating of periprosthetic supracondylar femoral fractures and compared the results according to extension of the fracture distal with the proximal border of the femoral prosthetic component. Between 1999 and 2008, 89 patients underwent lateral locked plating of a supracondylar periprosthetic femoral fracture, of whom 61 patients with a mean age of 72 years (42 to 96) comprising 53 women, were available after a minimum follow-up of six months or until fracture healing. Patients were grouped into those with fractures located proximally (28) and those with fractures that extended distal to the proximal border of the femoral component (33). Delayed healing and nonunion occurred respectively in five (18%) and three (11%) of more proximal fractures, and in two (6%) and five (15%) of the fractures with distal extension (p = 0.23 for delayed healing; p = 0.72 for nonunion, Fisher's exact test). Four construct failures (14%) occurred in more proximal fractures, and three (9%) in fractures with distal extension (p = 0.51). Of the two deep infections that occurred in each group, one resolved after surgical debridement and antibiotics, and one progressed to a nonunion. Extreme distal periprosthetic supracondylar fractures of the femur are not a contra-indication to lateral locked plating. These fractures can be managed with internal fixation, with predictable results, similar to those seen in more proximal fractures.
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Affiliation(s)
- P N Streubel
- Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, Missouri 63110, USA.
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Sah AP, Marshall A, Virkus WV, Estok DM, Della Valle CJ. Interprosthetic fractures of the femur: treatment with a single-locked plate. J Arthroplasty 2010; 25:280-6. [PMID: 19056231 DOI: 10.1016/j.arth.2008.10.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 10/10/2008] [Indexed: 02/01/2023] Open
Abstract
Interprosthetic fractures of the femur, those between an ipsilateral hip and knee arthroplasty, are challenging to treat secondary to limited bone available for fixation, osteopenic bone, a compromised intramedullary blood supply, and an often elderly patient population. From 2002 to 2006, 22 consecutive patients with an interprosthetic femur fracture were treated with a single-locking plate. Follow-up averaged 17.7 months, with fracture union achieved an average of 13.8 weeks postoperatively. All patients regained their preoperative ambulatory status and subjectively reported unchanged function of their hip and knee arthroplasties. Single-locked plating is an effective method of treatment of interprosthetic fractures of the femur. Emphasis on preservation of the soft tissue envelope and sufficient cortical purchase both above and below the fracture is of paramount importance.
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Liu F, Tao R, Cao Y, Wang Y, Zhou Z, Wang H, Gu Y. The role of LISS (less invasive stabilisation system) in the treatment of peri-knee fractures. Injury 2009; 40:1187-94. [PMID: 19535058 DOI: 10.1016/j.injury.2009.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 03/12/2009] [Accepted: 03/12/2009] [Indexed: 02/02/2023]
Abstract
The purpose of present study was to evaluate the role of LISS after a large series of patients in whom a fracture around the knee had been treated with this uniform technique. Between April 2004 and September 2006, 210 patients with a total of 216 fractures around the knee were treated with LISS, all at the Affiliated Hospital to Nantong University. Patients were followed for a mean of 27 months (range 12-42 months). 26 patients were excluded from the study. The remaining 184 patients with a total of 189 fractures of either distal femur (85 cases) or proximal tibia (104 cases) were available for analysis. The mean age of these patients was 49 years (range 18-82 years). Immediate postoperative X-rays showed the alignment of bone and joint was satisfactorily maintained with LISS in all cases and an ideal implant position in 176 cases (93%). All cases healed the fracture without non-union. The mean time to union was 15 weeks (range 12-27 weeks) for the femoral and 16 weeks (range 12-27 weeks) for the tibia fractures. Functional assessment was performed using HSS (hospital for special surgery) score. At the time of the latest follow-up, 158 patients (86%) had an excellent or good outcome. Overall, 3 patients were subject to a salvage operative procedure due to implant failure. Three cases underwent secondary bone graft for open fractures. Superficial and deep infection was found each in one patient and both were treated successfully. Hardware prominence irritation was found in 2 patients. LISS was removed in 27 patients after bone healing, and this procedure was neither less invasive nor easy as imagined. The results indicate the LISS system is perfect but by no means unique in the treatment of the fractures around the knee. The fixation is adequate enough to maintain alignment and obtain union with a low incidence of complications even in patients with osteoporotic bone. We firmly believe favourable results can be achieved when this device is combined with correct indications as well as skillful techniques.
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Affiliation(s)
- Fan Liu
- Department of Orthopaedics, The Affiliated Hospital to Nantong University, Jiangsu Province, PR China.
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41
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Meiners J, Faschingbauer M, Voigt C, Jürgens C, Schulz AP. Polyaxial Locked Implants in the Treatment of Type Vancouver B1 Periprosthetic Fractures of the Femur: Retrospective Clinical Examination in 58 Cases with Review of the Literature. Eur J Trauma Emerg Surg 2009; 36:53-9. [PMID: 26815569 DOI: 10.1007/s00068-009-8235-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 05/24/2009] [Indexed: 11/26/2022]
Abstract
We concluded a retrospective study of the outcomes of a consecutive series of Vancouver B1 and C femoral injuries using two specific locked implants. The study center is a dedicated trauma hospital with a large catchment area. Over a five-year period we treated 58 patients with a periprosthetic fracture of the femur with an angular stable plate, defined as the index procedure. The mean age at the index procedure was 72.4 years; 40 patients were female (69%). In 32 cases (55.2%) we saw a hip endoprosthesis, in 21 cases (36.2%) a knee endoprosthesis, and in five cases both (8.6%). Outcome measures were intra- and postoperative complications, bony union, degree of mobility and social status with comparison to the preoperative status, Barthel index, and timed ''up and go'' test. Union occurred in 56 cases (96.5%) after the index procedure. Three patients were bedridden before the injury; the remainder regained full weight-bearing status. The mean duration until full weight-bearing status in these patients was 8.6 weeks (4-13). Early implant failure with proximal dislocation of the screws occurred in two cases (3.5% revision rate). At follow up, 78% had maintained the same social status as before the injury. Fifty-two patients (89%) had regained their previous level of mobility. The mean Barthel index was 85 points (70-100) out of a possible 100, and improved from a mean of 35 points at the start of rehabilitation. It decreased on average by ten points compared to the preoperative status. The mean ''up and go'' time was measured as 21.4 s. In conclusion, polyaxial plates can achieve excellent surgical results. On the other hand, patients with this type of injury exhibit a clear deterioration in their social status, especially regarding lower limb motor function and self-independence.
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Affiliation(s)
- Jan Meiners
- Department of Trauma and Orthopedics, BG Trauma Hospital Hamburg, Hamburg, Germany
| | | | - Christine Voigt
- Department of Trauma and Orthopedic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christian Jürgens
- Department of Trauma and Orthopedics, BG Trauma Hospital Hamburg, Hamburg, Germany
- Department of Trauma and Orthopedic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Arndt P Schulz
- Department of Trauma and Orthopedics, BG Trauma Hospital Hamburg, Hamburg, Germany.
- Department of Trauma and Orthopedic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
- Department of Trauma and Orthopedics, BG Trauma Hospital Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany.
- Department of Trauma and Orthopedic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Currall V, Thomason K, Eastaugh-Waring S, Ward AJ, Chesser TJS. The use of LISS femoral locking plates and cabling in the treatment of periprosthetic fractures around stable proximal femoral implants in elderly patients. Hip Int 2009; 18:207-11. [PMID: 18924076 DOI: 10.1177/112070000801800303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A retrospective review was performed of Vancouver type C periprosthetic femoral fractures treated using the Less Invasive Stabilisation System (LISS) femoral locking plate system. Five patients with stable hip prostheses (only one of which was an uncomplicated primary arthroplasty) were treated with the LISS plating system in combination with bone grafting and cables. The average age at the time of fixation was 87 years (range 83-93). All fractures united and all but one of the patients was able to mobilise independently. One case was complicated by superficial wound infection, but there were no other significant complications. One patient is still alive 50 months after surgery; the remaining four died a mean of 27 months postoperatively. Our results indicate that the LISS system is effective in the management of Type C periprosthetic fractures around well-fixed proximal femoral implants in the elderly, even in complex cases.
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Affiliation(s)
- V Currall
- Department of Orthopaedics and Trauma, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK
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43
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Wutzler S, Laurer HL, Huhnstock S, Geiger EV, Buehren V, Marzi I. Periprosthetic humeral fractures after shoulder arthroplasty: operative management and functional outcome. Arch Orthop Trauma Surg 2009; 129:237-43. [PMID: 18807052 DOI: 10.1007/s00402-008-0746-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Currently, little information is available on functional outcome of periprosthetic humeral fractures after shoulder arthroplasty. This investigation aimed to evaluate functional and radiological outcome and patients' satisfaction following this type of injury treated by open reduction and internal fixation. METHODS Retrospective chart analysis of patients treated at two level-I trauma centers. Patients were examined clinically and radiologically. Additionally, functional outcome was assessed using the established DASH-questionnaire and standardized examination for calculation of the Constant score. RESULTS Five out of six patients showed complete fracture consolidation with satisfying functional results (mean follow up time 62 weeks). One patient showed major complications with poor outcome. DASH and Constant scores were comparable to those described after primary shoulder arthroplasty. CONCLUSIONS Periprosthetic humeral fractures after shoulder arthroplasty can be treated by angular stable plating with low complication rates and acceptable results.
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Affiliation(s)
- Sebastian Wutzler
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of J.W. Goethe-University, 60590 Frankfurt, Germany.
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Zuurmond RG, Pilot P, Verburg AD, van Os JJ, Verdonschot N. Retrograde bridging nail in periprosthetic femoral fracture treatment which allows direct weight bearing. Proc Inst Mech Eng H 2008; 222:629-35. [DOI: 10.1243/09544119jeim323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The bridging nail is a retrograde intramedullary femoral nail designed to stabilize periprosthetic femoral fractures. It offers a minimal invasive surgical approach in combination with early mobilization. The goal of this study was to evaluate the osteosynthesis under full weight-bearing conditions. Three groups of five composite fibreglass femora were prepared with a cemented hip stem. Group 1 underwent cyclic axial loading with 1500 N during 150 000 cycles. After completion, linear loading to failure was conducted. Groups 2 and 3 were submitted to linear increased torsional loading with and without an axial load respectively. Failure was defined as rotational movement of the connection (slippage). In the axial cyclic loading configuration, one specimen failed after 122 000 cycles. Four specimens passed 150 000 cycles and failed after linearly increasing the axial loading of 1940–2600 N (mean, 2408 N ± 313 standard deviation (SD)). Slippage was first detected at a torque varying between 2.5 and 8.2 N m (mean, 5.1 N m ± 2.1 SD) in group 2 and between 10.0 and 15.4 N m (mean, 13.0 N m ± 2.3 SD) in group 3. In conclusion the bridging nail offers a stable connection with the stem of a hip arthroplasty which can resist high repetitive loads, representative of direct full axial weight bearing. The biomechanical results support the clinical experience of a stable osteosynthesis enabling early post-operative mobilization.
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Affiliation(s)
- R G Zuurmond
- Department of Orthopaedic Surgery, Isala Clinics, Zwolle, The Netherlands
| | - P Pilot
- Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - A D Verburg
- Maasland Hospital Sittard, Sittard, The Netherlands
| | - J J van Os
- Maasland Hospital Sittard, Sittard, The Netherlands
| | - N Verdonschot
- Orthopaedic Research Laboratory, University Medical Center, St. Radboud, Nijmegen, The Netherlands
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45
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46
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Kobbe P, Klemm R, Reilmann H, Hockertz TJ. Less invasive stabilisation system (LISS) for the treatment of periprosthetic femoral fractures: a 3-year follow-up. Injury 2008; 39:472-9. [PMID: 18321509 DOI: 10.1016/j.injury.2007.10.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 09/22/2007] [Accepted: 10/05/2007] [Indexed: 02/02/2023]
Abstract
Recent publications have reported encouraging results with a locked plating system in the management of periprosthetic femoral fractures. However, data on mid- or long-term functional outcome is not available. Here we report on the mid-term functional outcome of 16 patients with a periprosthetic femoral fracture following total hip arthroplasty managed with the LISS-system at a 3-year follow-up. Functional outcome was measured using the Harris Hip score and the Karnofsky activity index. The Harris Hip score and the Karnofsky activity index averaged 79.5 points and 81%, respectively. There were a total of two major complications due to screw pullout representing a complication rate of 13%. This series suggests that the management of periprosthetic femoral fractures with the LIS-System results in a good mid-term functional outcome.
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Affiliation(s)
- Philipp Kobbe
- Department of Orthopaedic Trauma Surgery, Braunschweig, Germany.
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47
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Erhardt JB, Grob K, Roderer G, Hoffmann A, Forster TN, Kuster MS. Treatment of periprosthetic femur fractures with the non-contact bridging plate: a new angular stable implant. Arch Orthop Trauma Surg 2008; 128:409-16. [PMID: 17639435 DOI: 10.1007/s00402-007-0396-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We report the application of a new fixed angle plate (NCB DF, Zimmer inc. USA, Warsaw, IN) in the treatment of periprosthetic femur fractures. The NCB DF combines conventional plating technique with polyaxial screw placement and angular stability. DESIGN Prospective cohort study. SETTING A single level-1 trauma center. PATIENTS From May 2003 to December 2005, a total of 24 patients with periprosthetic femur fractures were treated. The NCB DF femur plate was used in all cases. The average follow-up period was 12 months (3-31 months). Twelve patients had a periprosthetic fracture after total knee replacement (TKA) and 12 patients after total hip replacement (THA). The mean period from primary joint replacement to periprosthetic fracture was 8.2 years for the THA group and 7.2 years for the TKA group. INTERVENTION A combined conventional/locking surgical technique was performed in all the cases. MAIN OUTCOME MEASURES Union, non-union, mal-union, duration of surgery, range of motion, postoperative mobility, subjective patient satisfaction and complications. RESULTS The union rate was 90%, the mal-union rate 5% and the re-operation rate 15%. Postoperative mobility reached the preoperative level in all but for two patients. Three complications occurred relating to the implant or the procedure: one fatigue failure of the plate (non-union), one screw breakage, and one wound infection. CONCLUSIONS The NCB DF combines conventional plating technique with polyaxial screw placement and angular stability. This combination technique shows promising results regarding union and mal-union rates in periprosthetic fractures in elderly and osteoporotic patients.
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Affiliation(s)
- J B Erhardt
- Klinik für Orthopädische Chirurgie, Kantonsspital St Gallen, 9007, St Gallen, Switzerland.
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Zuurmond RG, Pilot P, Verburg AD. Retrograde bridging nailing of periprosthetic femoral fractures. Injury 2007; 38:958-64. [PMID: 17306269 DOI: 10.1016/j.injury.2006.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 12/04/2006] [Accepted: 12/12/2006] [Indexed: 02/02/2023]
Abstract
A retrograde femoral nail was designed to slide over the tip of the femoral stem. Eighteen patients (4 male symbol, 14 female symbol) were treated with this retrograde nail between 1995 and 2003. The mean age was 81.4 years (range 61-96) with a mean follow-up of 21 months (range 4-61 months). Eight patients suffered from severe comorbidity. Mean surgical time was 91 min. Fourteen patients regained their preoperative functional level. Six patients died within the first post-operative year of natural causes. Their knee- and hip-function were reasonable considering the age group and co-morbidity. One revision was required and one patient had a protruding nail. In all patients radiological union of the fracture was seen between 4 and 12 months after surgery. Retrograde bridging nailing of the periprosthetic fractured femur is a therapeutic option in geriatric or impaired patients and can serve as a definitive implant.
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Affiliation(s)
- R G Zuurmond
- Resident Orthopaedic surgery, Martini Hospital Groningen, P.O. Box 30033, 9700 RM Groningen, The Netherlands.
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