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 Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate

2019 ◽  
Vol 10 ◽  
pp. 215145931987685 ◽  
Author(s):  
C. Baum ◽  
M. Leimbacher ◽  
P. Kriechling ◽  
A. Platz ◽  
D. Cadosch
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Operating Time ◽  
Group Versus ◽  
Revision Arthroplasty ◽  
Femoral Fractures ◽  
Length Of Hospital Stay ◽  
Invasive Procedure ◽  
Less Invasive ◽  
Revision Operations

Introduction: The Vancouver algorithm recommends revision arthroplasty (RA) for Vancouver type B2 (VTB2) fractures. However, open reduction and internal fixation (ORIF) using locking compression plates (LCP) may be a valid and less invasive alternative treatment. Materials and Methods: Between January 2007 and March 2017, we retrospectively recruited all patients treated with either ORIF with LCP or RA for VTB2 fractures in our clinic. All of the following were reviewed: the length of hospital stay, the operating time, the need for blood transfusions during and/or after surgery, implant-related and patient-related complications, need for revision surgery, and the radiological outcome. Additionally, the functional outcome was investigated. Results: Fifty-nine patients were recruited. Thirty-five (59.3%) patients underwent RA, while 24 (40.7%) patients received ORIF with LCP. The median surgical time was 137.50 minutes in the LCP group compared to 160.00 minutes in the RA group ( P = .051). Three (12.5%) patients in the LCP group and 10 (28.6%) patients in the RA group experienced an implant-associated complication ( P = .131). Patient-related complications occurred in 3 (12.5%) patients in the LCP group versus 6 (17.1%) patients in the RA group ( P = .628). The mean preoperative Parker mobility score was 9 points in both groups and decreased in both groups to a mean of 5 points in the LCP and 7 points in the RA group. Discussion: Open reduction and internal fixation with LCP seems to be a less invasive procedure for VTB2 fractures in comparison to RA. It is a bone-sparing procedure that can be advantageous for further revision operations. Moreover, some fractures can only be anatomically reduced by ORIF with LCP, whereas for proximal fractures with a radiologically unambiguously loosened stem RA might be advantageous. Conclusion: In line with previously published studies, our data suggest that ORIF using LCP is a valid treatment option for VTB2 fractures.

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.

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

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

scholarly journals Long-Term Incidence of Total Knee Arthroplasty after Open Reduction and Internal Fixation of Proximal Tibial and Distal Femoral Fractures: A Nationwide Cohort Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5685
Author(s):  
Kuang-Ting Yeh ◽  
Wen-Tien Wu ◽  
Ru-Ping Lee ◽  
Chen-Chie Wang ◽  
Jen-Hung Wang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Internal Fixation ◽  
Knee Arthroplasty ◽  
Open Reduction ◽  
Femoral Fractures ◽  
Posttraumatic Arthritis ◽  
Research Database ◽  
Fracture Group ◽  
Total Knee

Knee fractures often require open reduction internal fixation (ORIF) for knee function recovery. More than one fifth of patients with knee fractures subsequently develop posttraumatic arthritis, and over 5% of them need total knee arthroplasty (TKA). We conducted this nationwide retrospective cohort study using the data of 2,000,000 people in the general population who received TKA and were followed up in the 17-year period 2001–2017, through random sampling of the Taiwan National Health Insurance Research Database. We matched the ORIF and non-fracture groups by a propensity score, based on age, sex, index date of surgery, and comorbidities enrolled in CCI calculated at a 1:1 ratio. The average proportion of subjects receiving TKA after ORIF for distal femoral or proximal tibial fractures was 2.0 per 1000 person-years, which was significantly higher than that in the non-fracture group. Patients aged 20–65 years and males represented a significantly higher proportion of subjects receiving TKA after ORIF than that in the non-fracture group. The proportion of subjects receiving TKA for the 20–65-year subgroup of the ORIF group was 4%, and that for the male subgroup was 1.5%; both rates increased over the 17-year follow-up period. More aggressive intraoperative and postoperative adjuvant therapies may be necessary for these subgroups.

scholarly journals Management of Distal Femoral fractures with Locking Compression Plate- A Prospective study

2021 ◽  
Vol 12 (1) ◽  
pp. 61-68
Author(s):  
Abhijit Maruti Kadam ◽  
Sujay K Mahadik ◽  
Sagar Rampure ◽  
Rahil B Jiwani
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Knee Flexion ◽  
Open Reduction ◽  
Femoral Fractures ◽  
Common Type ◽  
Locking Compression Plate ◽  
Distal Femoral Fractures ◽  
Compression Plate ◽  
Type Of Fracture

Background: Distal femoral fractures are one of the common type of fractures seen after motor vehicular accidents. The optimal management of these fractures requires open reduction and internal fixation by plates and screws. Various studies have shown that open reduction and internal fixation by plates and screws result in early post-operative knee mobilization which is essential for good union and better functional outcome. Aims and Objective: The current study was conducted to evaluate the results of fracture lower end of femur treated by open reduction and internal fixation using locking compression plate. Materials and Methods: This was a prospective clinical study in which the cases with fracture lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Fractures were categorised by Mullers classification. All patients were treated by distal femoral locking compression plates and screws. The cases were followed up for radiological union and functional outcome (Neer’s scoring). The statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: Out of the 20 studied cases there were 13 (65%) males and 7 (35%) females with a M:F ratio of 1:0.53. Road traffic accidents were the most common cause (75%) of distal femoral fractures. The most common type of fracture seen in studied cases was found to be Mullers C2 type of fracture (45%) followed by Mullers C3 (20%) and Mullers C1 (15%). All patients were treated by open reduction and internal fixation. Mean Injury to surgery interval was found to be 4.25 days in studied cases. Postoperatively desirable knee flexion (1100) was achieved in 10 (50%) cases whereas in 8 patients 910-1090knee flexion was achieved. In 2 (10%) patients less than 900 knee flexion could be achieved. The functional outcome (as assessed by Neer’s score) showed that Good and fair results were seen in 13 (65 %) and 6 (30 %) patients. Poor functional outcome was seen in only 1 (5 %) patient. Conclusion: Locking compression plate is found to have good results in patients with traumatic distal femoral fractures in terms of early mobilization and functional outcome. Particularly in intra-articular fractures it provides good angular stability by its triangular reconstruction principle.

scholarly journals Pneumoretroperitoneum after Attempted Epidural Anesthesia

2016 ◽  
Vol 2 (4) ◽  
pp. 198-200 ◽  
Author(s):  
Arkadi Isakov ◽  
Arnold Shtein ◽  
Sholmo Kyzer
Keyword(s):  
Internal Fixation ◽  
Hip Joint ◽  
Epidural Anesthesia ◽  
Open Reduction ◽  
Rare Case ◽  
Femoral Fractures ◽  
Retroperitoneal Space ◽  
Hollow Viscus ◽  
Retroperitoneal Perforation

Abstract Air may extend to the retroperitoneal space from retroperitoneal perforation of a hollow viscus, infection of the anterior pararenal space with gas-forming organisms and from pneumothorax or pneumomediastinum [1]. Rare pathologies, such as open reduction and internal fixation of femoral fractures and anaerobic abscess of the hip joint have also been described in relation to this complication [1,2]. A rare case of pneumoretroperitoneum caused by insufflation of air during an attempt to achieve epidural anesthesia is described.

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