Conservative treatment after failure of internal fixation for periprosthetic femoral fractures: a report of two cases

2015 ◽  
Vol 135 (6) ◽  
pp. 773-779 ◽  
Author(s):  
Suk Kyu Choo ◽  
Youngwoo Kim ◽  
Myung Jin Shin ◽  
Hyoung-Keun Oh
Keyword(s):  
Conservative Treatment ◽  
Internal Fixation ◽  
Femoral Fractures ◽  
Periprosthetic Femoral Fractures

Treatment and outcomes of Vancouver type B periprosthetic femoral fractures

2020 ◽  
Vol 102-B (3) ◽  
pp. 293-300
Author(s):  
Hanlong Zheng ◽  
Hangyu Gu ◽  
Hongyi Shao ◽  
Yong Huang ◽  
Dejin Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Conservative Treatment ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Type B ◽  
Periprosthetic Femoral Fractures

Aims Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. Methods A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications. Results In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications. Conclusion The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: Bone Joint J 2020;102-B(3):293–300

Conservative Treatment for Minimally Displaced Type B Periprosthetic Femoral Fractures

2017 ◽  
Vol 32 (11) ◽  
pp. 3529-3532 ◽  
Author(s):  
Young-Kyun Lee ◽  
Jung Taek Kim ◽  
Ki-Choul Kim ◽  
Yong-Chan Ha ◽  
Kyung-Hoi Koo
Keyword(s):  
Conservative Treatment ◽  
Femoral Fractures ◽  
Type B ◽  
Periprosthetic Femoral Fractures

Principles of internal fixation and selection of implants for periprosthetic femoral fractures

Injury ◽  
2007 ◽  
Vol 38 (6) ◽  
pp. 669-687 ◽  
Author(s):  
Peter V. Giannoudis ◽  
Nikolaos K. Kanakaris ◽  
Eleftherios Tsiridis
Keyword(s):  
Internal Fixation ◽  
Femoral Fractures ◽  
Periprosthetic Femoral Fractures ◽  
Selection Of

Selected Vancouver B2 periprosthetic femoral fractures around cemented polished femoral components can be safely treated with osteosynthesis

2021 ◽  
Vol 103-B (7) ◽  
pp. 1222-1230
Author(s):  
Pablo A. Slullitel ◽  
Gonzalo G. Garcia-Barreiro ◽  
José I. Oñativia ◽  
Gerardo Zanotti ◽  
Fernando Comba ◽  
...  
Keyword(s):  
Adverse Events ◽  
Internal Fixation ◽  
Bone Cement ◽  
Revision Arthroplasty ◽  
Femoral Fractures ◽  
Implant Survival ◽  
Clinical Criteria ◽  
Cement Interface ◽  
Periprosthetic Femoral Fractures ◽  
Intact Bone

Aims We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. Methods We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups. Results In all, nine (8.01%) surgical failures were detected. All failures occurred within the first 24 months following surgery. The 24-month implant survival was 95.4% (95% confidence interval (CI) 89.13 to 100) for B1 fractures treated with internal fixation, 90% (95% CI 76.86 to 100) for B2 PFFs treated with osteosynthesis-only, and 85.8% (95% CI 74.24 to 97.36) for B2 fractures treated with revision THA, without significant differences between groups (p = 0.296). Readmissions and major adverse events including mortality were overall high, but similar between groups (p > 0.05). The two-year patient survival rate was 87.1% (95% CI 77.49 to 95.76), 66.7% (95% CI 48.86 to 84.53), and 84.2% (95% CI 72.63 to 95.76), for the B1 group, B2 osteosynthesis group, and B2 revision group, respectively (p = 0.102). Conclusion Implant survival in Vancouver B2 PFFs treated with internal fixation was similar to that of B1 fractures treated with the same method and to B2 PFFs treated with revision arthroplasty. Low-demand, elderly patients with B2 fractures around well-cemented polished femoral components with an intact bone-cement interface can be safely treated with internal fixation. Cite this article: Bone Joint J 2021;103-B(7):1222–1230.

Revision Arthroplasty Versus Open Reduction and Internal Fixation of Vancouver Type-B2 and B3 Periprosthetic Femoral Fractures

JBJS Reviews ◽  
2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Thomas Haider ◽  
Philip Hanna ◽  
Amin Mohamadi ◽  
Nelson Merchan ◽  
Megan McNichol ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Revision Arthroplasty ◽  
Femoral Fractures ◽  
Periprosthetic Femoral Fractures

scholarly journals Osteosynthesis and outcomes of traumatic periprosthetic femoral fractures after total hip arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Ali Taha ◽  
ElZaher Hassan ElZaher ◽  
Ibrahim ElGanzoury ◽  
Mostafa Ashoub ◽  
Amr Khairy
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Open Reduction ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Total Hip ◽  
Periprosthetic Femoral Fractures ◽  
The Mean

Abstract Purpose The aim of this retrospective study was to investigate the treatment of traumatic periprosthetic femoral fractures with open reduction and internal fixation. The outcomes with the use of the surgical techniques were also reported. Methods Between September 2017 and September 2019, 25 patients with traumatic periprosthetic femoral fractures were managed by open reduction and internal fixation in Ain Shams University Hospital, Egypt. The fixation methods were selected based on the surgeon’s preference. Outcomes were assessed using the Harris Hip Score, visual analogue score (VAS) for pain, and EuroQol 5 Dimensions – 5 Level (EQ5D-5L) prior to and after surgery. Patients were regularly followed up for one year. A P value < 0.05 was considered to be statistically significant. Results The mean age at surgery was 77 years (range, 51 to 95 years), 64% (n = 16) were females. According to the Vancouver classification, there were 1 type AG, 15 type B1, and 9 type C fractures. Postoperative complications included wound site infection (n = 2) and non-union (n = 1). The mean pre-trauma Harris Hip Score was 77.44 ± 8.63 (range, 65 to 90), and the mean Harris Hip Score collected at the final follow-up was 72.47 ± 8.85 (range, 60 to 86) (P < 0.05). The mean pre-trauma VAS was 2.20 ± 1.21 (range, 0 to 4), and the mean VAS recorded at the final follow-up was 3.00 ± 1.41 (range, 0 to 5) (P < 0.05). According to the EQ5D-DL assessed at the final follow-up, no patient felt that their daily life and activities became more problematic. Conclusion This study provided added validation of the current management of periprosthetic femoral fractures after total hip arthroplasty. Using the proper fixation and implant can achieve a reliable fixation and good functional recovery. Level of evidence IVa

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