Outcomes After Operative Fixation of Vancouver B2 and B3 Type Periprosthetic Fractures

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ameen Barghi ◽  
Philip Hanna ◽  
Nelson Merchan ◽  
Aron Lechtig ◽  
Christopher Haggerty ◽  
...  
Keyword(s):  
Periprosthetic Fractures ◽  
Operative Fixation

scholarly journals Periprosthetic Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
Alexander Lazarides ◽  
Tyler Vovos ◽  
James DeOrio ◽  
Mark Easley ◽  
James Nunley ◽  
...  
Keyword(s):  
Periprosthetic Fracture ◽  
Surgical Intervention ◽  
Nonoperative Management ◽  
High Rate ◽  
Periprosthetic Fractures ◽  
Medial Malleolus ◽  
Operative Fixation ◽  
Time To Fracture ◽  
Univariate Analyses

Category: Ankle Introduction/Purpose: Total ankle replacements (TAR) are an increasingly popular option for the management of tibiotalar arthritis. Periprosthetic fracture is an uncommon but challenging complication of patients undergoing arthroplasty. Evidence on the management of and outcomes from periprosthetic fractures about a TAR are limited. The purpose of this study was to evaluate patients with postoperative periprosthetic fractures about a TAR and determine clinical outcomes of these patients following operative fixation. Additionally, we propose an algorithm for the management of these patients. Methods: We retrospectively analyzed 400 patients who underwent TAR from 2007 through 2017. Charts were reviewed and patients with postoperative fractures were selected for inclusion. Patients with a fracture >4 weeks from index surgery were considered candidates for inclusion. Patients with intraoperative fractures were excluded. Univariate analyses were used to identify differences in outcomes. Results: 32 patients were identified with a postoperative periprosthetic fracture about a TAR. Average age was 65.3 years. Average time to fracture was 39.5 months while average follow up from fracture was 26 months. Fractures were primarily located about the medial malleolus (60.6%). 76.8% of fractures were deemed to be stable (Table 1); 75% of these fractures were managed with ORIF or IMN, while 21% of these fractures were treated with immobilization. 80% of patients with stable fractures treated with immobilization ultimately required surgical intervention. 24.2% of fractures were deemed to be unstable. Fractures about the talus were always unstable and always required revision TAR surgery (100%, p= 0.0002). Conclusion: This retrospective review demonstrates that the majority of periprosthetic fractures about a TAR involve the medial malleolus. Additionally, the majority of stable fractures about a TAR required operative fixation. Despite attempts at nonoperative management, management with immobilization is fraught with a high rate of subsequent surgical intervention. Fractures about the talus should be treated with revision TAR surgery or arthrodesis. Based on these findings, we propose an algorithm for the management of patients with a periprosthetic fracture about a TAR.

Algorithm for Management of Periprosthetic Ankle Fractures

2019 ◽  
Vol 40 (6) ◽  
pp. 615-621 ◽  
Author(s):  
Alexander L. Lazarides ◽  
Tyler J. Vovos ◽  
Gireesh B. Reddy ◽  
James K. DeOrio ◽  
Mark E. Easley ◽  
...  
Keyword(s):  
Periprosthetic Fracture ◽  
Nonoperative Treatment ◽  
High Rate ◽  
Periprosthetic Fractures ◽  
Medial Malleolus ◽  
Implant Stability ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Patient Reported ◽  
Operative Fixation

Background: Evidence on the management of and outcomes from periprosthetic fractures about a total ankle replacement (TAR) are limited. The purpose of this study was to develop an algorithm for the management of patients with postoperative periprosthetic fractures about a TAR. Methods: This was a retrospective analysis of patients undergoing a TAR from 2007 through 2017 with a subsequent periprosthetic fracture >4 weeks from index surgery. Implant stability was defined radiographically and intraoperatively where appropriate. Univariate and multivariate analyses were used to identify differences in outcomes. Thirty-two patients were identified with a remote TAR periprosthetic fracture with an average follow-up of 26 months (range, 3-104 months). Results: Most fractures were located about the medial malleolus (62.5%); the majority of fractures (75%) were deemed to have stable implants. Fractures of the talus always had unstable implants and always required revision TAR surgery (100%, P = .0002). There was no difference in patient-reported outcomes between stable and unstable fractures at an average of 36 months. In a multivariate analysis, fracture location (talus), less time to fracture, and implant type were found to be predictive of unstable implants ( P < .001). Implant stability was independently associated with the need for revision surgery ( P < .049). Nonoperative treatment was independently associated with treatment failure ( P < .001). Conclusion: The majority of stable fractures about a TAR required operative fixation. Management with immobilization was fraught with a high rate of subsequent surgical intervention. We found that fractures about the talus required revision TAR surgery or arthrodesis. Level of Evidence: Level III, retrospective cohort study.

The modern state of the treatment for periprosthetic fractures of the femur

TRAUMA ◽  
2017 ◽  
Vol 18 (3) ◽  
pp. 106-111
Author(s):  
P.I. Bilinskyi ◽  
V.A. Andreichyn ◽  
O.V. Drobotun
Keyword(s):  
Periprosthetic Fractures ◽  
Modern State ◽  
Fractures Of The Femur

scholarly journals A CASE REPORT: OPERATIVE FIXATION OF FLAIL CHEST IN THE VENTILATOR-DEPENDENT PATIENT

CHEST Journal ◽  
2020 ◽  
Vol 157 (6) ◽  
pp. A134
Author(s):  
K. Hughes ◽  
R. Kishan Adusumilli ◽  
M. Patel
Keyword(s):  
Case Report ◽  
Flail Chest ◽  
Operative Fixation ◽  
Dependent Patient

scholarly journals Quantification and Comparison of Talar Exposure Utilizing a Posteromedial Approach and Medial Malleolar Osteotomy

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110126
Author(s):  
Jeffrey Donahue ◽  
Ademola Shofoluwe ◽  
Kurt Krautmann ◽  
Emilio Grau-Cruz ◽  
Stephen Becher ◽  
...  
Keyword(s):  
Surface Area ◽  
Digital Image ◽  
National Institutes Of Health ◽  
Level Of Evidence ◽  
Posterior Process ◽  
Medial Malleolar Osteotomy ◽  
Fresh Frozen ◽  
Average Quantity ◽  
Operative Fixation ◽  
Imagej Software

Background: Fractures of the talus are a rare but challenging injury. This study sought to quantify the area of osseous exposure afforded by a posteromedial approach to the talus and medial malleolar osteotomy. Methods: Five fresh-frozen cadaveric lower extremities were dissected using a posteromedial approach and medial malleolar osteotomy respectively. Following exposure, the talar surfaces directedly visualized were marked and captured using a calibrated digital image. The digital images were then analyzed using ImageJ software (National Institutes of Health) to calculate the surface area of the exposure. Results: The average square area of talus exposed using the posteromedial approach was 9.70 cm2 (SD = 2.20, range 7.20-12.46). The average quantity of talar exposure expressed as a percentage was 9% (SD = 1.58, range 7.03-10.40). The average square area of talus exposed using a medial malleolar osteotomy was 14.32 cm2 (SD = 2.00, range 11.26-16.66). The average quantity of talar exposure expressed as a percentage was 12.94% (SD = 1.79, range 9.97-14.73). The posteromedial approach provided superior visualization of the posterior talus, whereas the medial malleolar osteotomy offered greater access to the medial body. Conclusion: The posteromedial approach and medial malleolar osteotomy allow for significant exposure of the talus, yielding 9.70 and 14.32 cm2, respectively. Given the differing portions of the talus exposed, surgeons may prefer to use the posteromedial approach for operative fixation of posterior process fractures and elect to use a medial malleolar osteotomy in cases requiring more extensive medial and distal exposure for neck or neck/body fractures. Level of Evidence: Level IV.

scholarly journals Factors affecting the incidence of postoperative periprosthetic fractures following primary and revision hip arthroplasty: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Christos Bissias ◽  
Angelos Kaspiris ◽  
Athanasios Kalogeropoulos ◽  
Konstantinos Papoutsis ◽  
Nikolaos Natsioulas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Revision Arthroplasty ◽  
Female Gender ◽  
Periprosthetic Fractures ◽  
Factors Affecting ◽  
Potential Risk Factors ◽  
Grade 3

Abstract Objectives The increasing number of hip arthroplasties (HA), due to the growing elderly population, is associated with the risk of femoral periprosthetic fractures (FPFs). The purpose of this study was to identify potential risk factors for the development of FPFs after HA. Methods A systematic review was conducted in five data bases (Medline, Embase, Cochrane, Cinahl, ICTRP) according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines up to May 2019, using the key words “risk factor,” “periprosthetic fracture,” and “hip replacement or arthroplasty.” Meta-analysis of the clinical outcomes of HA and subgroup analysis based on the factors that were implicated in FPFs was performed. Results Sixteen studies were included (sample size: 599,551 HA patients, 4253 FPFs, incidence 0.71%). Risk factors statistically associated with increased incidence of FPFs were female gender (+ 40%), previous revision arthroplasty surgery (× 3 times), and the presence of rheumatoid arthritis (× 2.1 times), while osteoarthritis (− 57%), cement application (− 59%), and insertion of Biomet (− 68%) or Thompson’s prosthesis (− 75%) were correlated with low prevalence of FPFs. Obesity, cardiac diseases, advanced age, bad general health (ASA grade ≥ 3), and use of Exeter or Lubinus prosthesis were not linked to the appearance of FPFs. Conclusion This meta-analysis suggested that female gender, rheumatoid arthritis, and revision arthroplasty are major risk factors for the development of FPFs after a HA. In those patients, frequent follow-ups should be planned. Further prospective studies are necessary to clarify all the risk factors contributing to the appearance of FPFs after HA.

scholarly journals Union rates and functional outcome of double plating of the femur: systematic review of the literature

2021 ◽  
Author(s):  
M. F. Lodde ◽  
M. J. Raschke ◽  
J. Stolberg-Stolberg ◽  
J. Everding ◽  
S. Rosslenbroich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fracture Healing ◽  
Functional Outcome ◽  
Femoral Fractures ◽  
Periprosthetic Fractures ◽  
Level Of Evidence ◽  
Distal Femoral Fractures ◽  
Femur Fractures ◽  
Meta Analyses ◽  
Double Plating

Abstract Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

scholarly journals Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern

2021 ◽  
Author(s):  
M. F. R. Powell-Bowns ◽  
E. Oag ◽  
D. Martin ◽  
N. D. Clement ◽  
C. E. H. Scott
Keyword(s):  
Multivariate Analysis ◽  
Interobserver Reliability ◽  
Univariate Analysis ◽  
Intraclass Correlation ◽  
Cement Mantle ◽  
Mantle Length ◽  
Periprosthetic Fractures ◽  
Stem Design ◽  
Female Sex ◽  
Radiographic Measurements

Abstract Introduction The aim of this study was to identify factors associated with the level of periprosthetic fracture involving a cemented polished tapered stem: Vancouver B or Vancouver C. Methods A retrospective cohort study of 181 unilateral periprosthetic fractures involving Exeter stems was assessed by three observers (mean age 78.5, range 39–103; mean BMI 27.1, 17–39; 97 (54%) male). Patient demographics, deprivation scores, BMI and time since primary prosthesis were recorded. Femoral diameter, femoral cortical thickness, Dorr classification and distal cement mantle length were measured from calibrated radiographs. Interobserver reliability was calculated using intraclass correlation coefficients (ICCs). Univariate and multivariate analysis was performed to identify associations with Vancouver B or C fractures. Results 160/181 (88%) Vancouver B and 21/181 (12%) Vancouver C-level fractures occurred at a mean of 5.9 ± 5.4 years (0.2–26.5) following primary surgery. Radiographic measurements demonstrated excellent agreement (ICC > 0.8, p < 0.001). Mortality was significantly higher following Vancouver C compared to B fractures: 90 day 14/160 Vs 5/21 (p = 0.05); 1 year 29/160 Vs 8/21 (p = 0.03). Univariate analysis demonstrated that Vancouver C fractures were associated with female sex, bisphosphonate use, cortical bone thickness, and distal cement mantle length (p < 0.05). On multivariate analysis, only female sex was an independent predictor of Vancouver C-level fractures (R2 =0.354, p = 0.005). Conclusion Most PFFs involving the Exeter stem design are Vancouver B-type fractures and appear to be independent of osteoporosis. In contrast, Vancouver C periprosthetic fractures display typical fragility fracture characteristics and are associated with female sex, thinner femoral cortices, longer distal cement mantles and high mortality.

Sign in / Sign up

Export Citation Format

Share Document