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Esper GW, Meltzer-Bruhn AT, Anil U, Schwarzkopf R, Macaulay W, Konda SR, Ganta A, Egol KA. Periprosthetic fracture following arthroplasty for femoral neck fracture: is a cemented stem protective? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1927-1935. [PMID: 38462554 DOI: 10.1007/s00590-023-03830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/28/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Periprosthetic femoral fractures (PFF) carry significant morbidity following arthroplasty for femoral neck fracture (FNF). This study assessed fracture complications following arthroplasty for FNF and the effect of cement fixation of the femoral component on intraoperative and post-operative PFF. METHODS Between February 2014 and September 2021, 740 patients with a FNF who underwent arthroplasty were analyzed for demographics, surgical management, use of cement for fixation of the femoral component, and subsequent PFF. Variables were compared with Mann-Whitney or Chi-square as appropriate. Multivariate logistic regression was used to assess independent risk factors associated with intraoperative or post-operative PFF. RESULTS There were 163 THAs (41% cemented) and 577 HAs (95% cemented). There were 28 PFFs (3.8%): 18 post-operative and 10 intraoperative. Fewer post-operative PFFs occurred with cemented stems (1.63% vs. 6.30%, p = 0.002). Mean time from surgery to presentation with post-operative PFF was 14 months (0-45 months). Mean follow-up time was 10.3 months (range: 0-75.7 months). In multivariate regression, use of cement and THA was independently associated with decreased post-operative PFF (cement: OR 0.112, 95% CI 0.036-0.352, p < 0.001 and THA: OR 0.249, 95% CI 0.064-0.961, p = 0.044). More intraoperative fractures occurred during THA (3.68% vs. 0.69%, p = 0.004) and non-cemented procedures (5.51% vs. 0.49%, p < 0.001). In multivariate regression, use of cement was protective against intraoperative fracture (OR 0.100, CI 0.017-0.571, p = 0.010). CONCLUSIONS In patients with a FNF treated with arthroplasty, cementing the femoral component is associated with a lower risk of intraoperative and post-operative PFF. Choice of procedure may be based on patient factors and surgeon preference.
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Affiliation(s)
- Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Ariana T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Utkarsh Anil
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - William Macaulay
- Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA.
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Wongsak S, Sa-Ngasoongsong P, Pinitkwamdee S, Thongchuea N, Prasai AB, Warinsiriruk E, Jarungvittayakon C, Jaovisidha S, Chanplakorn P. Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system. Injury 2022; 53:2454-2461. [PMID: 35660012 DOI: 10.1016/j.injury.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Periprosthetic femoral fracture (PFF) is well-known complication in cementless hip arthroplasty (HA), especially in the elderly with osteoporosis. To prevent intraoperative PFFs during HA, prophylactic cerclage wiring on the calcar area during femoral broaching and implant insertion is recommended. However, biomechanical data on the benefits of cerclage wiring in osteoporotic bone during impaction are limited and controversial. This study aimed to assess the efficacy of prophylactic double-looped cerclage wiring (PDLCW) during femoral broaching in the osteoporotic bone model with an impaction simulation system. METHODS Fifteen osteoporotic femur models were prepared and allocated to three groups; control group (no cerclage), PW group (received PDLCW), and CC+PW group (prepared as having calcar crack and received PDLCW). All femurs were broached under impaction force that sequentially increased until the visible fracture or calcar crack propagation was visible. The primary outcomes were mallet impaction force (MIF-CF) and mallet velocity (MV-CF) at the time of calcar fracture. The secondary outcomes were calcar fracture pattern and subsidence during calcar fracture (S-CF). RESULTS PW group showed a significant increase in average MIF-CF, by 40.4% and 120.2% (p<0.001) compared to the control and CC+PW groups, respectively. The average MV-CF in PW group was also significantly greater, 13.1% and 64.6% (p<0.001), compared to the control and CC+PW groups, respectively. Control group revealed significantly greater incidence of complete calcar fracture (60% vs. 0% vs. 0%, p = 0.024), and the highest S-CF compared to those in the PW and CC+PW groups (10.6 ± 6.0 mm, 6.7 ± 4.4 mm, and 1.3 ± 2.0 mm, p = 0.020). CONCLUSIONS This study showed that PDLCW significantly improved hoop stress resistance by increasing the calcar fracture threshold related to mallet impaction, decreasing the risk of complete calcar fracture.
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Affiliation(s)
- Siwadol Wongsak
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Siwadol Pinitkwamdee
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Nutchanat Thongchuea
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
| | - Abigyat Babu Prasai
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand
| | - Eakkachai Warinsiriruk
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
| | - Chavarat Jarungvittayakon
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suphaneewan Jaovisidha
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
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Mazzawi E, Ghrayeb N, Khury F, Norman D, Keren Y. A comparison between Austin-Moore and Corail prosthesis regarding intraoperative periprosthetic femur fractures in hip hemiarthroplasty. Sci Rep 2022; 12:6340. [PMID: 35428861 PMCID: PMC9012879 DOI: 10.1038/s41598-022-10384-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 11/09/2022] Open
Abstract
Hip hemiarthroplasty is considered the treatment of choice for displaced femoral neck fractures in elderly less active patients. One important complication of this procedure is an intraoperative periprosthetic femur fracture (IPF), which may lead to poor functional outcome and may increase morbidity and mortality. Our primary aim in this study is to compare between Austin-Moore and Corail prosthesis regarding IPFs. Our secondary aim is to assess patient and surgical technique related risk factors for the development of this complication. Inclusion criteria included patients older than 65 years of age who had a displaced femoral neck fracture and were operated for hip hemiarthroplasty between the years 2014-2018. Patient-specific data was collected retrospectively including age, gender, comorbidities, pre-injury ambulatory status, duration of surgery, surgical approach, use of Austin-Moore or Corail prosthesis, surgeon's experience and type of anesthesia applied. In addition, radiographs were reviewed for measurement of calcar to canal ratio (CDR) and classification of Dorr canal type. 257 patients with an average age of 83.7 years were enrolled in the study. 118 patients (46%) were treated with an Austin-Moore prosthesis, while 139 (54%) were treated with a Corail prosthesis. A total of 22 patients (8.6%) had intraoperative fractures. Fracture prevalence was significantly higher in the Corail group compared with the Austin-Moore group (12.2% vs. 4.2%, p = 0.025). The majority of patients had a Dorr A type femoral canal, while the rest had Dorr B type canal (70% vs. 30%). There was no difference in fracture prevalence between Dorr A and B canal type patients. We didn't find any significant risk factor for developing an IPF, neither patient wise (age, gender, and comorbidities) nor surgical technique related (surgical approach, type of anesthesia, and surgeon's experience). Intraoperative periprosthetic fracture prevalence was significantly higher in the Corail patient group compared with the Austin-Moore group. This may be an important advantage of the Austin-Moore prosthesis over the Corail prosthesis.
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Affiliation(s)
- Elias Mazzawi
- Orthopedic Division, Rambam Healthcare Campus, Haifa, Israel.
| | - Nabil Ghrayeb
- Orthopedic Division, Rambam Healthcare Campus, Haifa, Israel
| | - Farouk Khury
- Orthopedic Division, Rambam Healthcare Campus, Haifa, Israel.,Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Doron Norman
- Orthopedic Division, Rambam Healthcare Campus, Haifa, Israel
| | - Yaniv Keren
- Orthopedic Division, Rambam Healthcare Campus, Haifa, Israel
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Bellova P, Baecker H, Lotzien S, Brandt M, Schildhauer TA, Gessmann J. Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties. J Orthop Surg Res 2019; 14:432. [PMID: 31829214 PMCID: PMC6907126 DOI: 10.1186/s13018-019-1494-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/27/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility. METHODS We retrospectively reviewed 481 bipolar hemiarthroplasties for displaced femoral neck fractures; of which, 421 (87.5%) were performed without cement, from January 2013 to March 2018. Data on the patients' demographics, comorbidities, femoral canal geometry (Dorr canal type, Canal Flare Index), surgeon's experience (junior vs. senior surgeon), and timing of surgery (daytime vs. on-call duty) were obtained. In patients with intraoperative fractures, further information was obtained. Patient mobility was assessed using matched-pair analysis. Mobility was classified according to the NHFD mobility score. The chi-square test, Fisher's exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. The data analysis was performed using SPSS. RESULTS Of 481 procedures, 34 (7.1%) IPFs were encountered. The Dorr canal type C was identified as a significant risk factor (p = .004). Other risk factors included female sex (OR 2.30, 95% CI .872-6.079), stovepipe femur (OR 1.749, 95% CI .823-3.713), junior surgeon (OR 1.204, 95% CI .596-2.432), and on-call-duty surgery (OR 1.471, 95% CI .711-3.046), although none showed a significant difference. Of 34 IPFs, 25 (73.5%) were classified as Vancouver type A. The treatment of choice was cerclage wiring. Within the 12 matched pairs identified, the postoperative mobility was slightly worse for the IPF group (delta = .41). CONCLUSIONS IPF is a serious complication with bipolar hemiarthroplasty. The identification of risk factors preoperatively, in particular femur shape, is crucial and should be incorporated into the decision-making process.
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Affiliation(s)
- Petri Bellova
- Department of Orthopedic and Trauma Surgery, BG University Clinic Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Hinnerk Baecker
- Department of Orthopedic and Trauma Surgery, BG University Clinic Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Sebastian Lotzien
- Department of Orthopedic and Trauma Surgery, BG University Clinic Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | | | - Thomas A Schildhauer
- Department of Orthopedic and Trauma Surgery, BG University Clinic Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Jan Gessmann
- Department of Orthopedic and Trauma Surgery, BG University Clinic Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
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The prevalence of fracture extension in displaced femoral neck fractures in the elderly. OTA Int 2019; 2:e033. [PMID: 33937665 PMCID: PMC7997120 DOI: 10.1097/oi9.0000000000000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/02/2019] [Indexed: 11/27/2022]
Abstract
Objective: Arthroplasty is the common treatment for intracapsular femoral neck fractures in the elderly. Recent studies have shown that there may be more overall complications related to uncemented hemiarthroplasty compared to cemented, including more subsidence, intraoperative fractures, and postoperative fractures. Uncemented femoral components rely on a press fit, and the risk of these complications would be expected to increase in patients with unrecognized distal extension of femoral neck fractures. The purpose of this study is to determine the frequency of fracture extension of displaced femoral neck fractures in the elderly population. Methods: The electronic medical record database at our institution was retrospectively reviewed to search for consecutive reports from 2005 to 2015 of patients 65 years or older that sustained an intracapsular femoral neck fracture who had computed tomography (CT) examinations of the injury. Exclusion criteria were CTs that were not fine cut (<1.5 mm cuts) or occult femoral neck fractures that were seen only on magnetic resonance imaging. This resulted in 60 patients that were included in the study. Within this subset of patients, the CT scans were reassessed to look for extension of the fracture beyond the boundaries of the femoral neck. Of particular interest, were fracture lines that extended distal to the femoral neck, since these have the potential to affect the fit of an uncemented femoral stem. Data on subject age, gender, body mass index (BMI), and bone mineral density (BMD) were also collected, and it was determined if these demographics were predictive in patients having fracture extension. Treatment and follow-up data were collected for the patients as well. Results: Seven of 60 patients were identified to have fracture extension of intracapsular femoral neck fractures. The frequency of fracture extension of intracapsular femoral neck fractures distal to the femoral neck was 8.3% (5/60). All cases of fracture extension were nondisplaced or minimally displaced. 60% (3/5) of the distal fracture extensions were not diagnosed preoperatively by the radiologists or the treating orthopaedic surgeons. There was not a statistically significant difference when comparing age, gender, BMI, or BMD of the population group with distal fracture extension to that of the rest of the patient cohort. Conclusions: To our knowledge, this is the first study to report the frequency of fracture extension of displaced femoral neck fractures in the elderly population. The 8.3% rate of distal fracture extension in elderly femoral neck fractures may help explain the higher rate of subsidence, postoperative fracture and intraoperative fracture when applying uncemented hemiarthroplasty compared to cemented arthroplasty. It is important to be aware of the potential for this phenomenon.
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Outcomes of cerclage wiring to manage intra-operative femoral fracture occurring during cementless hemiarthroplasty in older patients with femoral neck fractures. INTERNATIONAL ORTHOPAEDICS 2019; 43:2637-2647. [DOI: 10.1007/s00264-019-04327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/28/2019] [Indexed: 01/06/2023]
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Hong CC, Nashi N, Tan JH, Manohara R, Lee WT, Murphy DP. Intraoperative periprosthetic femur fracture during bipolar hemiarthroplasty for displaced femoral neck fractures. Arch Orthop Trauma Surg 2018; 138:1189-1198. [PMID: 29770880 DOI: 10.1007/s00402-018-2952-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We aim to review the incidence and risk factors for the development of intraoperative periprosthetic femur fractures while performing a bipolar hemiarthroplasty for displaced neck of femur fractures. Our secondary aim is to characterize the types of intraoperative periprosthetic fractures, the steps leading to the fractures, and the salvage treatments instituted. MATERIALS AND METHODS 271 patients treated with bipolar hemiarthroplasty after traumatic displaced femoral neck fractures were retrospectively analyzed. Demographic data, co-morbidities, vitamin D level, consumption of steroids, ASA score, surgical approach, surgeon experience, use of cemented or uncemented implants, proximal femur morphology, and types of anaesthesia were analyzed statistically. RESULTS There were 28 patients (10.3%) with intraoperative periprosthetic femur fractures. We found two significant independent risk factors which were the use of uncemented prosthesis (OR 4.15; 95% CI 1.65-10.46; p = 0.003) and Dorr type C proximal femurs (Dorr A OR 3.6; 95% CI 1.47-8.82; p = 0.005). In addition, patients with Dorr type C proximal femurs who underwent uncemented bipolar hemiarthroplasty were more likely to sustain an intraoperative periprosthetic fracture (14(73.7%) out of 19 patients; p = 0.002). There were no significant differences found in other risk factors. The most common location for these fractures was at the greater trochanter at 11 (39.3%) cases. Majority of them, 15 (53.6%), had intraoperative fractures during trial implant insertion and reduction. CONCLUSION The overall incidence of intraoperative periprosthetic femur fractures during hemiarthroplasty for displaced neck of femur fractures was 10.3%. The incidence was significantly higher for uncemented (14.7%) when compared to cemented prosthesis (5.4%) and the greater trochanter was the commonest area for periprosthetic fractures during trial implant insertion and reduction. Uncemented prosthesis and Dorr type C proximal femurs were two significant independent risk factors contributing to intraoperative periprosthetic fractures. By identifying these risk factors, surgeons can take ample precautions to prevent complications.
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Affiliation(s)
- Choon Chiet Hong
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Nazrul Nashi
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jiong Hao Tan
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Ruben Manohara
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Wei Ting Lee
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Diarmuid Paul Murphy
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
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Wejjakul W, Chatmaitri S, Wattanarojanaporn T, Pongkunakorn A, Ittiwut C, Shotelersuk V. Bilateral Femoral Neck Fractures in Cerebrotendinous Xanthomatosis Treated by Hip Arthroplasties: The First Case Report and Literature Review. J Orthop Case Rep 2017. [PMID: 29242796 DOI: 10.13107/jocr.2250‐0685.894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage disease caused by mutations of the CYP27A1 gene and deficiency of the sterol-27-hydroxylase enzyme in bile acid biosynthesis. It is characterized by the accumulation of cholestanol and bile alcohols in plasma, the formation of xanthomatous lesions in various tissues, and organ degeneration. This disorder is also associated with osteoporosis and increased risk of fracture. To date, only two CTX patients with femoral neck fractures have been reported. Neither was treated by arthroplasties, and the operative outcomes are lacking. Case Report We report the case of a 46-year-old Thai female who presented with consecutive bilateral femoral neck fractures following minor trauma within a 3-year period and received cementless bipolar hemiarthroplasties. Her phenotypic expression included Achilles tendon masses, childhood-onset cataracts, intellectual disability, and cerebellar ataxia. A brain computed tomography showed non-enhancing hypodense lesions in the bilateral cerebellar hemispheres with mild brain atrophy. Histopathology from an Achilles tendon biopsy revealed tendinous xanthoma and molecular analysis confirmed a homozygous nonsense mutation, c.1072C>T (p.Gln358Ter), in exon 6 of the CYP27A1 gene. The intra-operative crack of a calcar femorale was a major complication during both prosthetic insertion surgeries and warranted cerclage wiring. At the 7-month follow-up of the right hip and the 41-month follow-up of the left hip, postoperative radiographs showed well-fixed and well-aligned prostheses. Independent household ambulation could be resumed with Harris hip scores of 81 points equally. Conclusion CTX is associated with osteoporosis, and middle-aged patients could present with femoral neck fracture following minor trauma. Cementless bipolar hemiarthroplasty for a totally displaced fracture is justified for a patient who has cognitive impairment. Intra-operative fracture is a major complication during prosthetic insertion and warrants cerclage wiring to achieve predictable bone healing and a satisfactory result.
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Affiliation(s)
- Witchuree Wejjakul
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Swist Chatmaitri
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | | | - Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Chupong Ittiwut
- Center of Excellence for Medical Genetics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Wejjakul W, Chatmaitri S, Wattanarojanaporn T, Pongkunakorn A, Ittiwut C, Shotelersuk V. Bilateral Femoral Neck Fractures in Cerebrotendinous Xanthomatosis Treated by Hip Arthroplasties: The First Case Report and Literature Review. J Orthop Case Rep 2017; 7:54-58. [PMID: 29242796 PMCID: PMC5728000 DOI: 10.13107/jocr.2250-0685.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage disease caused by mutations of the CYP27A1 gene and deficiency of the sterol-27-hydroxylase enzyme in bile acid biosynthesis. It is characterized by the accumulation of cholestanol and bile alcohols in plasma, the formation of xanthomatous lesions in various tissues, and organ degeneration. This disorder is also associated with osteoporosis and increased risk of fracture. To date, only two CTX patients with femoral neck fractures have been reported. Neither was treated by arthroplasties, and the operative outcomes are lacking. Case Report: We report the case of a 46-year-old Thai female who presented with consecutive bilateral femoral neck fractures following minor trauma within a 3-year period and received cementless bipolar hemiarthroplasties. Her phenotypic expression included Achilles tendon masses, childhood-onset cataracts, intellectual disability, and cerebellar ataxia. A brain computed tomography showed non-enhancing hypodense lesions in the bilateral cerebellar hemispheres with mild brain atrophy. Histopathology from an Achilles tendon biopsy revealed tendinous xanthoma and molecular analysis confirmed a homozygous nonsense mutation, c.1072C>T (p.Gln358Ter), in exon 6 of the CYP27A1 gene. The intra-operative crack of a calcar femorale was a major complication during both prosthetic insertion surgeries and warranted cerclage wiring. At the 7-month follow-up of the right hip and the 41-month follow-up of the left hip, postoperative radiographs showed well-fixed and well-aligned prostheses. Independent household ambulation could be resumed with Harris hip scores of 81 points equally. Conclusion: CTX is associated with osteoporosis, and middle-aged patients could present with femoral neck fracture following minor trauma. Cementless bipolar hemiarthroplasty for a totally displaced fracture is justified for a patient who has cognitive impairment. Intra-operative fracture is a major complication during prosthetic insertion and warrants cerclage wiring to achieve predictable bone healing and a satisfactory result.
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Affiliation(s)
- Witchuree Wejjakul
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Swist Chatmaitri
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | | | - Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Chupong Ittiwut
- Center of Excellence for Medical Genetics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Kim SJ, Park HS, Lee DW, Kim JH. Lower preoperative Hounsfield unit values are associated with intra-operative fractures in cementless bipolar hemiarthroplasty. Arch Osteoporos 2017; 12:110. [PMID: 29218502 DOI: 10.1007/s11657-017-0406-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/27/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED The use of Hounsfield units (HU) from CT scanning to assess regional BMD has been described. Therefore, we evaluated whether HU could be used to identify osteoporosis of the proximal part of the femur. The results showed that HU assessment is associated with the presence of intra-operative fracture during arthroplasty. INTRODUCTION The aim with this study was to determine the association of preoperative Hounsfield unit (HU) in hip computed tomography (CT) with intra-operative osteoporotic fracture during cementless hemiarthroplasty. METHODS In this retrospective study, we reviewed all patients who underwent cementless bipolar hemiarthroplasty for femoral neck fractures between 2014 and 2016. Patients with intra-operative metaphyseal fractures (n = 25) during surgery were identified from a retrospectively collected patient database and matched with nonfracture controls (n = 75) on the basis of age and sex. The differences between patients with intra-operative fractures and without intra-operative fractures were compared regarding preoperative HU. Correlations of HU value of femur neck with BMD and T scores were determined. RESULTS Analysis of HU values at the fracture level showed a significantly lower value in the fracture group than in the controls (1186 vs 1340, p = 0.005). The correlation between HU and BMD of femur neck was significant (r 2 = 0.347; p < 0.001). The correlation between HU of femur neck and BMD of spine was also significant (r 2 = 0.133; p < 0.001). CONCLUSIONS HU assessment using preoperative CT scan is associated with the presence of intra-operative fracture during bipolar hemiarthroplasty. We believe that HU values of the proximal femur could be used to assess local bone quality.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul, 132-703, South Korea.
| | - Hyun-Soo Park
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul, 132-703, South Korea
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul, 132-703, South Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, 136-705, South Korea
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