Concepts and Potential Future Developments for Treatment of Periprosthetic Proximal Femoral Fractures

Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies.

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Supracondylar fracture of femur: our experience of treatment with locking compression plate from rural Maharashtra

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190064 ◽

2019 ◽

Vol 5 (2) ◽

pp. 232

Author(s):

Kiran P. Paknikar ◽

Shekhar Malve ◽

G. S. Kulkarni ◽

M. G. Kulkarni ◽

S. G. Kulkarni ◽

...

Keyword(s):

Femoral Fractures ◽

Healing Time ◽

Locking Compression Plate ◽

Supracondylar Fracture ◽

Osteoporotic Bone ◽

Complication Rates ◽

Compression Plate ◽

Post Graduate Institute ◽

Metaphyseal Fractures ◽

Prospective Longitudinal

Background: Surgical treatment of supracondylar or intercondylar distal femoral fractures (AO/OTA types 33-A to 33-C) remains a significant surgical challenge with significant complication rates. Supracondylar and intercondylar fractures of femur are very often difficult to treat and they are notorious for many complications. We have studied use of LCP (locking compression plate) in the treatment of metaphyseal fractures. These implants improve fracture healing, especially in osteoporotic bone due to better holding capacity. Objective wass to assess the efficacy of LCP in maintenance of post-operative distal femoral alignment and in preventing post-operative varus collapse in supracondylar fracture of femur.Methods: Prospective Longitudinal observational study Conducted at Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra involving 50 patients with supracondylar fracture. The fractures were classified as supracondylar femur fracture (AO/OTA type 33) (A- C). Fractures that were supracondylar with significant proximal fracture extension were classified as an AO/OTA type 33 fracture unless there was a separate diaphyseal fracture. Data was analysed by using SPSS 16.0 version and expressed as percentages.Results: Majority of patients were from 30-39 years age group i.e. 32%. Majority of patients were males i.e. 46 (92%). 7 (14%) patients had healing time <4 months. 24 (48%) patients had healing time between 4-6 months. 19 (38%) patients had healing time more than 6 months. To assess the overall results, we used Knee society score. In 38% of patients, we found excellent results. Good and fair results were seen in 32% and 26% of patients.Conclusion: Locking compression plate is an ideal implant for fixation of supracondylar fracture of femur 33 (A-C) especially in C3 type where articular comminution is present.

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Primary Stability in Hip Revision Arthroplasty: Comparison of the Stability of Cementless Fixed Augments on a Modular Acetabular Cage System with and without Cranial Straps

Journal of Clinical Medicine ◽

10.3390/jcm10174002 ◽

2021 ◽

Vol 10 (17) ◽

pp. 4002

Author(s):

Max Jaenisch ◽

Hendrik Kohlhof ◽

Dieter Christian Wirtz ◽

Frank Alexander Schildberg ◽

Nicholas A. Beckmann ◽

...

Keyword(s):

Relative Motion ◽

Revision Arthroplasty ◽

Primary Stability ◽

Fourth Generation ◽

Group Assignment ◽

Cage System ◽

Fixation Techniques ◽

Prior Investigation ◽

The Stability

The goal of this study is to evaluate the primary stability of a cementless augment-and-modular-cage system with and without the addition of cranial straps in a standardized in vitro setting. As the surrogate parameter for the evaluation of primary stability, the measurement of relative motion between the implant components themselves and the bone will be used. Acetabular revision components with a trabecular titanium augment in combination with a large fourth-generation composite left hemipelvis were assembled. These constructs were divided into two groups with (S) and without cranial straps (nS). A total of 1000 cycles was applied at each of three load levels. Relative movements (RM) between the components were measured. Load levels display a significant effect on the amount of RM at all interfaces except between shell/augment. The group assignment appears to have an effect on RM due to significantly differing means at all interfaces. Between bone/shell RM increased as load increased. NS displayed significantly more RM than S. Between shell/augment RM remained constant as load increased. Between shell/cup S showed more RM than nS while both groups’ RM increased with load. We conclude a significant increase of primary stability between the shell and the bone through the addition of cranial straps. Relative motion between components (shell/cup) increases through the addition of cranial straps. A clinical impact of this finding is uncertain and requires further investigation. Finally, the cementless fixation of the augment against the rim-portion of the shell appears stable and compares favorably to prior investigation of different fixation techniques.

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Proximal femur locking compression plate in Subtrochanteric Fractures : a prospective analysis

10.36106/ijsr/7101906 ◽

2019 ◽

pp. 66-68

Author(s):

Kailasnath M.S ◽

K. Subramanian ◽

G. Pugazhendhi

Keyword(s):

Femoral Fractures ◽

Early Mobilization ◽

The Elderly ◽

Bimodal Distribution ◽

High Energy ◽

Locking Compression Plate ◽

Harris Hip Score ◽

Osteoporotic Bone ◽

Compression Plate ◽

Mobility Score

Introduction:Sub-trochanteric femoral fractures are injuries that mostly affect the elderly population.Ithasa bimodal distribution. In young and healthy individuals, the injury results from high energy trauma, where as in the elder age group, most of the fractures are in osteoporotic bone resulting from a trivial fall. The aim of the surgery is to achieve initial stability and early mobilization of the patients and to avoid complications. The aim of our study is to analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these fractures. Materials and Methods:We prospectively analyzed30sub-trochantericfemoral fractures treated with PF-LCP from January 2015 to December 2018. There were 20 females (66.6%) and 10 males (33.4%) with an average age of 61.2 years (range, 36 to 75 years). The sub-trochanteric fractures are classified by Seinshemier's classification. The functional outcome was evaluated by Harris Hip Score and the Parker Palmer Mobility Score at 12 months follow-up. Results:Among 30 patients, 27 patients (90%) obtained fracture union without further intervention; 3 patients required additional bone grafting at the end of 3 months. There were no cases of hip screw cutting the femoral head. There was no post-operative mortality in our study. The average Harris Hip Score was 87 (80-93). The assessment by Parker and Palmar Mobility Score was 7.8(range 5-9). Conclusions:The PF-LCP is a good stable alternative in the treatment of sub-trochanteric femoral fractures. It providesgood to excellent bone healing with limited complications.

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Fixation of intraoperative proximal femoral fractures during THA using two versus three cerclage wires - a biomechanical study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04956-5 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Toni Wendler ◽

Melanie Edel ◽

Robert Möbius ◽

Johannes Fakler ◽

Georg Osterhoff ◽

...

Keyword(s):

Cyclic Loading ◽

Failure Load ◽

Peak Load ◽

Femoral Fractures ◽

Primary Stability ◽

The Body ◽

Invasive Technique ◽

Load Testing ◽

Proximal Femoral Fractures ◽

Mineral Density

Abstract Background Intraoperative proximal femoral fractures (IPFF) are relevant complications during total hip arthroplasty. Fixation using cerclage wires (CW) represents a minimally-invasive technique to address these fractures through the same surgical approach. The goal of treatment is to mobilise the patient as early as possible, which requires high primary stability. This study aimed to compare different cerclage wire configurations fixing IPFF with regard to biomechanical primary stability. Methods Standardised IPFF (type II, Modified Mallory Classification) were created in human fresh frozen femora and were fixed either by two or three CW (1.6 mm, stainless steel). All cadaveric specimens (n = 42) were randomised to different groups (quasi-static, dynamic) or subgroups (2 CW, 3 CW) stratified by bone mineral density determined by Dual Energy X-ray Absorptiometry. Using a biomechanical testing setup, quasi-static and dynamic cyclic failure tests were carried out. Cyclic loading started from 200 N to 500 N at 1 Hz with increasing peak load by 250 N every 100 cycles until failure occurred or maximum load (5250 N) reached. The change of fracture gap size was optically captured. Results No significant differences in failure load after quasi-static (p = 0.701) or dynamic cyclic loading (p = 0.132) were found between the experimental groups. In the quasi-static load testing, all constructs resisted 250% of the body weight (BW) of their corresponding body donor. In the dynamic cyclic load testing, all but one construct (treated by 3 CW) resisted 250% BW. Conclusions Based on this in vitro data, both two and three CW provided sufficient primary stability according to the predefined minimum failure load (250% BW) to resist. The authors recommend the treatment using two CW because it reduces the risk of vascular injury and shortens procedure time.

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Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03332-7 ◽

2020 ◽

Vol 140 (10) ◽

pp. 1381-1394 ◽

Cited By ~ 2

Author(s):

Karl Stoffel ◽

Michael Blauth ◽

Alexander Joeris ◽

Andrea Blumenthal ◽

Elke Rometsch

Keyword(s):

Revision Arthroplasty ◽

Femoral Fractures ◽

Cement Mantle ◽

Anatomic Reconstruction ◽

Successful Outcome ◽

Original Research ◽

Outcome Predictors ◽

Complication Rates ◽

Stem Revision ◽

Periprosthetic Femoral Fractures

Abstract Introduction Hip arthroplasty (HA) is commonly performed to treat various hip pathologies. Its volume is expected to rise further due to the increasing age of the population. Complication rates are low; however, periprosthetic femoral fractures (PFF) are a rare, albeit serious, complication with substantial economic impact. While current guidelines propose revision with long-stemmed prostheses for all Vancouver B2 and B3 PFF, some recent research papers suggest that open reduction with internal fixation (ORIF) could lead to an equivalent outcome. Our aim was to summarize the evidence, elucidating under which circumstances ORIF leads to a favorable outcome after B2 and B3 PFF compared with revision surgery. Materials and methods A systematic literature search was performed to identify studies on patients treated with ORIF and with stem revision after B2 and/or B3 fractures. Extracted information included initial pathology, stem fixation mechanism, bone quality and stem stability at the time of PFF, clinical outcomes, and mortality. Results of individual studies were summarized in a table in lieu of a quantitative data synthesis due to a lack of standardized information. Results We identified 14 original research articles including both patients treated with ORIF and with stem revision after B2 and/or B3 PFF. Five studies included statistical comparisons, all were in favor of ORIF or indeterminate. The common lack of rigorous statistical analyses and significant methodological weaknesses made identification of outcome predictors impossible. Conclusion The choice of treatment modality for PFF depends on fracture, implant, and bone characteristics. Recent data show that successful outcome can be achieved without revising loose stems. ORIF may be a viable option if bone stock is adequate around uncemented or tapered polished stems with an intact cement mantle and the fracture geometry allows stable anatomic reconstruction. Conceptional considerations support this idea, but more data are needed to identify outcome predictors.

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