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

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

scholarly journals Periprosthetic Femoral Fractures in Total Hip Arthroplasty (THA): Comparison Between Osteosynthesis and Revision

2021 ◽  
Author(s):  
Gianluca Scalici ◽  
Debora Boncinelli ◽  
Luigi Zanna ◽  
Roberto Buzzi ◽  
Laura Antonucci ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Total Hip ◽  
Periprosthetic Femoral Fractures ◽  
Oxford Hip Score ◽  
Type Of Fracture

Abstract Background Periprosthetic fractures are challenging complication of hip arthroplasty and a rare injury, but their incidence is increasing. The surgical treatment is demanding to achieve early mobilization and avoid the complications of prolonged recumbency. The aim of this study is to evaluate the clinical outcomes of surgical treatment in periprosthetic femoral fractures of hip arthroplasty, making a comparison between implant revision and reduction and internal fixation of the fracture.Methods Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. We collected the data of 70 patients who satisfied inclusion criteria. The fractures were classified according to the Unified Classification System (UCS) and randomized in two groups: reduction and internal fixation (G1) or revision arthroplasty (G2). Clinical outcomes were assessed with Oxford Hip Score post and pre-surgery, Barthel Score in relation to CIRS score (Cumulative illness rating scale), the type of fracture and post-operative complications with a minimum follow up of one year.Results Nominal univariable statistical analysis revealed significantly results concerning the difference between the post and pre-operative Oxford Hip Score (D Oxford) with type of treatment (p=0,008) and with the CIRS score (p=0,048). Moreover, we observed a strong significant relationship between type of treatment and type of fracture (P=0,0001). Multivariable analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery (P=0,024).Conclusions Authors reported how the surgical revision has a better functional outcome in B2 type of fracture than B1 or C, but the chosen treatment should be related to surgeon’s experience and patient’s comorbidities and a multidisciplinary team.

scholarly journals Nutritional Insufficiency as a Predictor for Adverse Outcomes in Adult Spinal Deformity Surgery

2017 ◽  
Vol 8 (2) ◽  
pp. 164-171 ◽  
Author(s):  
Kevin Phan ◽  
Jun S. Kim ◽  
Joshua Xu ◽  
John Di Capua ◽  
Nathan J. Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Adult Spinal Deformity ◽  
Cohort Analysis ◽  
Adverse Outcomes ◽  
Red Blood Cell Transfusion ◽  
Improvement Program ◽  
Adult Deformity ◽  
Nutritional Insufficiency

Study Design: Retrospective analysis of prospectively collected data. Objective: The effect of malnutrition on outcomes after general surgery has been well reported in the literature. However, there is a paucity of data on the effect of malnutrition on postoperative complications during adult deformity surgery. The study attempts to explore and quantify the association between hypoalbuminemia and postoperative complications. Methods: A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing adult deformity surgery were separated into cohorts based serum albumin (<3.5 or >3.5 g/dL). Chi-square and multivariate logistic regression models were used to identify independent risk factors. Results: A total of 2236 patients met the inclusion criteria for the study, of which 2044 (91.4%) patients were nutritionally sufficient while 192 (8.6%) patients were nutritionally insufficient. Multivariate logistic regressions revealed nutritional insufficiency as a risk factors for mortality (odds ratio [OR] = 15.67, 95% confidence interval [CI] = 6.01-40.84, P < .0001), length of stay ≥5 days (OR = 2.22, 95% CI = 1.61-3.06, P < .0001), any complications (OR = 1.82, 95% CI = 1.31-2.51, P < .0001), pulmonary complications (OR = 2.29, 95% CI = 1.29-4.06, P = .005), renal complications (OR = 2.71, 95% CI = 1.05-7.00, P = .039), and intra-/postoperative red blood cell transfusion (OR = 1.52, 95% CI = 1.08-2.12, P = .015). Conclusions: This study demonstrates that preoperative hypoalbuminemia is a significant and independent risk factor for postoperative complications, 30-day mortality, and increased length of hospital in patients undergoing adult deformity surgery surgery. Nutritional status is a modifiable risk factor that can potentially improve surgical outcomes after adult deformity surgery.

scholarly journals Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes

2019 ◽  
Vol Volume 14 ◽  
pp. 427-435 ◽  
Author(s):  
Louis de Jong ◽  
Veronique van Rijckevorsel ◽  
Jelle W. Raats ◽  
Taco M.A.L. Klem ◽  
Tjallingius M. Kuijper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Femoral Fractures ◽  
Proximal Femoral Fractures ◽  
Hip Hemiarthroplasty

scholarly journals Midterm results of consecutive periprosthetic femoral fractures Vancouver type A and B

2016 ◽  
Vol 6 (3) ◽  
Author(s):  
Klemens Trieb ◽  
Rainer Fiala ◽  
Christian Briglauer
Keyword(s):  
Femoral Fractures ◽  
Type A ◽  
Periprosthetic Femoral Fracture ◽  
Type B ◽  
Single Center ◽  
Midterm Results ◽  
Periprosthetic Femoral Fractures ◽  
Multimorbid Patients ◽  
Lost To Follow Up

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow- up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications.

Risk factors for surgical complications after D2 gastrectomy following neoadjuvant chemotherapy for gastric cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 164-164
Author(s):  
Takaki Yoshikawa ◽  
Toru Aoyama ◽  
Tsutomu Hayashi ◽  
Kazuaki Tanabe ◽  
Kazuhiro Nishikawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Phase Ii ◽  
Surgical Complications ◽  
Phase Ii Trial ◽  
D2 Gastrectomy ◽  
Randomized Phase Ii ◽  
D2 Surgery

164 Background: The feasibility and safety of D2 surgery following neoadjuvant chemotherapy (NAC) has not yet been fully evaluated in patients with gastric cancer. Moreover, the risk factors for surgical complications after D2 gastrectomy following NAC are also unknown. The aim of the present study was to identify risk factors for postoperative complications after D2 surgery following NAC. Methods: This study was conducted as an exploratory analysis of a prospective randomized phase II trial of NAC. This randomized phase II trial compared two and four courses of neoadjuvant S-1/cisplatin (SC) and paclitaxel/cisplatin (PC) using a two-by-two factorial design for locally advanced gastric cancer. Sample size was set at 60 to 80 to achieve 10% improvement of 3-year OS by four courses or by PC with approximately 80% probability of the correct selection. The surgical complications were assessed and classified according to the Clavien-Dindo classification. The uni- and multivariate logistic regression analyses were performed to identify risk factors for morbidities. Results: Among the 83 patients who were registered in the phase II trial, 69 patients received NAC and D2 gastrectomy. Postoperative complications were identified in 18 patients, and the overall morbidity rate was 26.1%. The results of the univariate and multivariate analyses of various factors potentially affecting the overall surgical morbidity identified a creatinine clearance (CCr) < 60ml/min (P = 0.016) as the sole significant independent risk factor for overall morbidity. The incidence of pancreatic fistula was significantly higher in the patients with a low CCr than in those with a high CCr. Conclusions: A low CCr was found to be a significant risk factor for surgical complications associated with D2 gastrectomy after NAC. Careful attention is therefore required for these patients. Clinical trial information: UMIN000002595.

scholarly journals Cement-in-cement stem revision for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty

2009 ◽  
Vol 80 (5) ◽  
pp. 548-552 ◽  
Author(s):  
Toby W Briant-Evans ◽  
Darmaraja Veeramootoo ◽  
Eleftherios Tsiridis ◽  
Matthew J Hubble
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Fractures ◽  
Type B ◽  
Total Hip ◽  
Stem Revision ◽  
Periprosthetic Femoral Fractures
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