Journal of Musculoskeletal Trauma

Recurrent Treatment Failure in Vancouver Classification Type C Periprosthetic Fractures around a Well Fixed Short Femoral Stem: Byeong Yeol Choi, Hong-Man Cho, Jiyeon Park; J Korean Fract Soc 2022;35(1):16-20. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.16

Abstract PDF: A short femoral stem (type 1 cementless stem) is being increasingly used to perform total hip arthroplasty; however, various types of intra- or postoperative periprosthetic fractures have been reported in recent times. A 66-year-old woman with a history of bilateral total hip arthroplasties using a type 1B femoral stem was admitted 2 months post-operation for a Vancouver type C periprosthetic fracture. She underwent open reduction and internal fixation; however, we observed recurrent non-union and plate breakage at the same site. In this case report, we discuss the factors associated with treatment failure in patients with a Vancouver type C periprosthetic fracture following type 1 femoral stem im-plantation.

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Rendezvous Surgery for Peri-Implant Fractures around Locking Compression Plate on Anterolateral Bowed Femur - A Case Report -: Hong Man Cho, Jiyeon Park; J Korean Fract Soc 2020;33(3):159-163. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.159

Abstract PDF: An 84-year-old female visited with an intertrochanteric femoral fracture. The patient had undergone an open reduction and internal fixation with a compressive plate and elastic nail in an ipsilateral atypical diaphyseal femoral fracture in the past. Compressive plate and elastic nail remained, and anterolateral bowing was presented. To treat the periprosthetic trochanteric fracture, a proximal femoral nail was used without removing the previously inserted compressive plate. Under the “rendezvous” technique, using a combination of fixating intramedullary nail and compressive plate simultaneously, the distal screw was fixed, and a femoral head lag screw was inserted after reducing the fracture. Complete union of the fracture was achieved 16 months after the operation, and a decrease in mobility function was not found postoperatively. The authors report this case for the “rendezvous” technique as a treatment option for elderly patients with periprosthetic trochanteric fractures, who had previously undergone surgical treatment for ipsilateral atypical diaphyseal femoral fractures with anterolateral bowing.

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Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty: Hyunseok Seo, Jin-Hyung Im, Joo-Yup Lee; J Korean Fract Soc 2020;33(2):110-117. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.110

The indications for total elbow replacement arthroplasty (TERA) include rheumatoid arthritis, degenerative arthritis, acute fracture, nonunion, malunion, posttraumatic arthritis, tumor, and chronic instability. With the development of designs and the increasing use of TERA, more periprosthetic fractures are occurring. On the other hand, there is less data on periprosthetic fractures after TERA because TERA is a relatively rare procedure. Thus, a careful review of the previous literature and appropriate selection of surgical indications are essential for achieving a satisfactory outcome, which should be accompanied by precise surgery as planned. This article presents the causes, risk factors, classification, and principles of treatment of periprosthetic fractures after TERA.

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Intramedullary fibula strut bone allograft in a periprosthetic humeral shaft fracture with implant loosening after total elbow arthroplasty
Young-Hoon Jo, Seung Gun Lee, Incheol Kook, Bong Gun Lee
Clinics in Shoulder and Elbow.2020; 23(3): 152. CrossRef

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Periprosthetic Fractures following Total Knee Arthroplasty: Byung Hoon Lee, Jae Ang Sim; J Korean Fract Soc 2020;33(1):52-61. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.52

Abstract PDF: Recently, as the elderly population increases, the incidence of total knee arthroplasty has increased, with a concomitant increase in the frequency of periprosthetic fractures. To determine the treatment plan for fractures, the treatment method should be determined by the patient's age, osteoporosis, fixation status of the implant, and type of fracture. In recent years, operative treatment with reduction and stable fixation, rather than non-operative treatment, was used to promote early joint movement and gait. On the other hand, it is necessary to select an appropriate operative method to reduce complications of surgery, such as nonunion and infection, and expect a good prognosis. In this review, periprosthetic fractures were divided into femur, tibia, and patella fractures, and their causes, risk factors, classification, and treatment are discussed.

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Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty: Jung Hoon Choi, Jong Hyuk Jeon, Kyung Jae Lee; J Korean Fract Soc 2020;33(1):43-51. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.43

Abstract PDF: Although the incidence of postoperative periprosthetic femoral fractures after hip arthroplasty is expected to increase, these complex fractures are still challenging complications. To obtain optimal results for these fractures, thorough clinical and radiographic evaluation, precise classification, and understanding of modern management principles are mandatory. The Vancouver classification system is a simple, effective, and reproducible method for planning proper treatments of these injuries. The fractures associated with a stable femoral stem can be effectively treated with osteosynthesis, though periprosthetic femoral fractures associated with a loose stem require revision arthroplasty. We describe here the principles of proper treatment for the patients with periprosthetic femoral fractures as well as how to avoid complications.

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Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion: Soo young Jeong, Jae Ho Lee, Ki Chul Park; J Korean Fract Soc 2019;32(4):188-195. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.188; Correction in: J Musculoskelet Trauma 2020;33(1):62

Abstract PDF

PURPOSE
Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (ageâ‰¥60) and to determine the risk factors related witht he occurrence of nonunion.
MATERIALS AND METHODS
This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion.
RESULTS
The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045).
CONCLUSION
The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.

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Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture
Jae Kwang Hwang, KiWon Lee, Dong-Kyo Seo, Joo-Yul Bae, Myeong-Geun Song, Hansuk Choi
Journal of the Korean Fracture Society.2023; 36(3): 77. CrossRef

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Principles for Management of Periprosthetic Acetabular Fractures after Hip Arthroplasty: Chan Woo Park, Hyoung Keun Oh, Woo Suk Lee, Youn Soo Park, Seung Jae Lim; J Korean Fract Soc 2019;32(3):148-156. Published online July 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.3.148

Abstract PDF

Periprosthetic acetabular fracture (PAF) is an uncommon complication following hip arthroplasty. However, as the number of people needing hip prostheses continues to rise, the absolute number of PAF is expected to increase as well. These fractures may occur either intraoperatively or postoperatively. Postoperative fractures can be caused by traumatic events or by pathologic conditions related to periacetabular osteolysis. The management of PAF usually depends on the degree of displacement and the stability of the acetabular component. While most of non-displaced fractures can be managed nonoperatively by protected weight bearing, displaced fractures with unstable implants require surgical intervention, which is often technically challenging. This review summarized the latest findings on the epidemiology, the diagnosis, the classification, and the treatment of PAF.

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Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty
Jung-Hoon Choi, Jong-Hyuk Jeon, Kyung-Jae Lee
Journal of the Korean Fracture Society.2020; 33(1): 43. CrossRef

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Periprosthetic Fracture after Hook Plate Fixation in Neer Type II Distal Clavicle Fracture: A Report of 3 Cases: Kyung Yong Kim, Joon Yub Kim, Won Bok Lee, Myong Gon Jung, Jeong Hyun Yoo, Joo Hak Kim; J Korean Fract Soc 2016;29(1):55-60. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.55

Abstract PDF

Hook plate fixation is a treatment method for the displaced distal clavicle fracture with favorable results regarding bone union and shoulder function, however possible complications include impingement syndromes, subacrormial erosions, acromial fractures, and periprosthetic fractures. In this report, we observed 3 cases of periprosthetic fracture after hook plate fixation. All cases of periprosthetic fractures were initiated at the medial end screw holes. The causes of these periprosthetic fractures appeared to be the off centered fixation of medial end screws near the anterior or posterior cortex which were specific during operations with hook plates with more than 6 holes and the increased stress on the medial end screw by over-reduced or inferiorly reduced position of the distal end of the clavicle by the hook plate.

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Comparison of a novel hybrid hook locking plate fixation method with the conventional AO hook plate fixation method for Neer type V distal clavicle fractures
Joongbae Seo, Kang Heo, Seong-Jun Kim, Jun-Kyom Kim, Hee-Jung Ham, Jaesung Yoo
Orthopaedics & Traumatology: Surgery & Research.2020; 106(1): 67. CrossRef
Comparative analysis of a locking plate with an all-suture anchor versus hook plate fixation of Neer IIb distal clavicle fractures
Joong-Bae Seo, Kwon-young Kwak, Jae-Sung Yoo
Journal of Orthopaedic Surgery.2020;[Epub] CrossRef
Comparison of Locking Compression Plate Superior Anterior Clavicle Plate with Suture Augmentation and Hook Plate for Treatment of Distal Clavicle Fractures
Jun-Cheol Choi, Woo-Suk Song, Woo-Sung Kim, Jeong-Muk Kim, Chan-Woong Byun
Archives of Hand and Microsurgery.2017; 22(4): 247. CrossRef

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Treatment of Periprosthetic Femoral Fractures Following Total Knee Arthroplasty: Lih Wang, Kyu Yeol Lee, Chul Hong Kim, Myung Jin Lee, Min Soo Kang, Jin Soo Hwang, Sun Hyo Kim; J Korean Fract Soc 2014;27(1):42-49. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.42

Abstract PDF

PURPOSE
The purpose of this study is to compare the treatment results of fracture fixations by using two minimal invasive techniques for patients with periprosthetic femoral fractures following total knee arthroplasty.
MATERIALS AND METHODS
We reviewed 36 patients (5 males, 31 females) of periprosthetic femoral fractures whom were treated surgically between January 2005 and January 2011. Mean patient age was 68.9 years (range, 43 to 81 years) old and the follow-up period averaged 41 months (range, 18 to 72 months). Nineteen patients were treated with minimal invasive locking plate fixations (group I) and 17 patients with retrograde intramedullary nailing (group II). Clinical and radiological outcomes in each group were comparatively analyzed.
RESULTS
Successful bone unions occurred in all patients and the mean time to bone union was 3.7 months in group I and 4.2 months in group II. There were no statistical differences between the two groups according to mean operative time and mean intraoperative blood loss. There were also no statistical differences between two groups according to clinical outcomes but the valgus deformity was apparent in group II and radiological outcomes revealed significant differences between the two groups.
CONCLUSION
For the treatment of periprosthetic femoral fractures after total knee arthroplasty, two minimal invasive techniques have shown good clinical results. However, the minimal invasive plate fixation showed better results in the radiological alignments.

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The Result of Treatment of Femoral Periprosthetic Fractures after Total Knee Arthroplasty
Jun-Beom Kim, In-Soo Song, Dong-Hyuk Sun, Hyun Choi
Journal of the Korean Orthopaedic Association.2014; 49(6): 446. CrossRef

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Risk Factors of Periprosthetic Fracture after Total Knee Arthroplasty: Ju Young Shin, Hyung Jun Kim, Seung Han Cha, Dong Heon Kim; J Korean Fract Soc 2012;25(1):1-7. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.1

Abstract PDF: PURPOSE
To evaluate the incidence rate and risk factors for periprosthetic fracture after total knee replacement (TKR).
MATERIALS AND METHODS
We carried out a retrospective case-control study of 596 patients (951 knees) who underwent TKR between 1999 and 2006 and who were followed up over 36 months. We classified patients into group I (study group) and group II (control group). We subdivided risk factors as pre-operative, intra-operative, and post-operative factors. Age, osteoporosis, revision arthroplasty, CVA, and alcohol dependence were categorized as pre-operative factors; anterior femoral notching and prosthetic types (mobile, fixed, and load-bearing) were considered intra-operative factors; and post-operative activity level was classified as a post-operative factor. We obtained information from the patients' charts, X-ray film, and telephone interviews.
RESULTS
The overall incidence rate was 2.25%; 3 patients were male, and 18 were female (14.28% and 85.72%, respectively). Old age (p<0.01, odds ratio=1.14), osteoporosis (p=0.01, odds ratio=4.74), revision arthroplasty (p=0.01, odds ratio=7.46), CVA (p=0.02, odds ratio=8.55), and alcohol dependence (p=0.03, odds ratio=44.54) were statistically significant among the pre-operative factors. Among the intra-operative factors, anterior femoral notching (p<0.01, odds ratio=11.74) was significant, and continued heavy labor (p<0.01, odds ratio=8.14) was significant among the post-operative factors.
CONCLUSION
We concluded that old age, osteoporosis, revision arthroplasty, comorbidity related with falling down, anterior femoral notching, and continued heavy labor were associated with periprosthetic fracture after TKR.

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Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing: A Case Report: Jae Hyuk Shin, Ho Guen Chang, Young Woo Kim, Nam Kyou Rhee, Yong Bok Park, Yong Kuk Kim; J Korean Fract Soc 2011;24(2):185-190. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.185

Abstract PDF

Periprosthetic fracture following a proximal humeral intramedullary (IM) nailing is rarely reported neither for its occurrence nor for its treatment. Proximal humeral IM nail (Acumed, LLC, Hillsboro, OR, USA) has been increasingly reported of its successful treatment outcomes, yet there is paucity of data describing its complications. Here we report a 26 year-old female patient, who sustained a proximal humerus fracture which was initially successfully treated by proximal humeral IM nail, and was complicated by a periprosthetic fracture distal to the nail tip at postoperative 4 months. Serial application of U-shaped coaptation splint, hanging cast, and functional bracing resulted in satisfactory clinical outcome. Periprosthetic fracture after proximal humerus IM nail can occur by a low energy injury, which need to reminded in treating young and sports-active patients.

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Locking compression plate fixation of periprosthetic distant humeral fracture after intramedullary nail for humeral shaft fracture: A case report
Mei-Ren Zhang, Kui Zhao, Jiang-Long Guo, Hai-Yun Chen
Trauma Case Reports.2022; 37: 100565. CrossRef
Distal Humeral Fixation of an Intramedullary Nail Periprosthetic Fracture
Hiren M. Divecha, Hans A. J. Marynissen
Case Reports in Orthopedics.2013; 2013: 1. CrossRef

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Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail: Moon Jib Yoo, You Jin Kim, Jin Won Lee; J Korean Fract Soc 2008;21(1):19-23. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.19

Abstract PDF: PURPOSE
Retrograde intrameullary nail is one of the treatment of periprosthetic supracondylar femoral fracture after total knee replacement (TKR), but all TKRs will not permit to insert a supracondylar nail. Therefore, we have investigated the compatibility of the TKRs with supracondylar nail.
MATERIALS AND METHODS
Using trial femoral component of the 5 used TKRs in Korea and saw bone model, we checked their compatibility and measured the dimensions of the intercondylar notches in both cruciate retaining (CR) and posterior stabilized (PS) type.
RESULTS
Although most CR prostheses had an intercondylar notch large enough to accept a supracondylar nail, in some case, this was not possible due to the notch being situated too far posteriorly. The position of the intercondylar notch is also important factor in the PS prostheses.
CONCLUSION
The notch position, rather than the notch size, was the most important factor in determining nail compatibility with femoral stem.

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Midterm Results of Treatment with a Retrograde Nail for Periprosthetic Fractures of the Femur Following Total Knee Arthroplasty: Kyung Taek Kim, Jin Hun Kang, Lih Wang, Jae Sung Hwang; J Korean Fract Soc 2007;20(4):309-314. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.309

Abstract PDF: PURPOSE
To analyze the midterm results of the treatment with a retrograde nail for periprosthetic fractures of the femur following total knee arthroplasty.
MATERIALS AND METHODS
Between Jan 1998 and Jan 2004, 11 cases in 11 patients were treated for the periprosthetic fractures following total knee arthroplasty. The mean follow-up was 42.0 (30~98) months and the mean age was 66.0 (57~79) years old. 2 were males and 9 patients were females. In all cases, retrograde nailing was done for the periprosthetic fractures. Postoperative range of motion, HSS knee rating score, femorotibial angle, the time required for union, complications were evaluated.
RESULTS
Postoperative range of motion was 103.6Â° degrees on an average, HSS knee rating score was 83.5 points on an average at the last follow up. The mean angulation on radiograph was valgus 6.3Â°. The mean time required for union was 4 months. One had a newly fracture line at proximal part of supracondylar fracture, but there was no significant in clinical course. There was no prostheses required revision.
CONCLUSION
It appears that retrograde nail is a reliable surgical technique for periprosthetic fractures of the femur following total knee arthroplasty with low complication rate. The midterm results in our study showed that none of the prostheses required revision.

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The Problems of Plate Fixation in the Management of Periprosthetic Femoral Fracture: Myung Sik Park, Byung Wan Choi, Hyun kyung Bae, Jong Hyuk Park; J Korean Soc Fract 2003;16(2):148-154. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.148

Abstract PDF: PURPOSE
The purpose was to evaluate the postoperative periprosthetic femur fracture of hip arthroplasty and relative problems of management using plate fixation. MATERIAL AND METHOD: We reviewed 37 cases of femoral fractures out of 1,270 (1,183 primary hips and 97 revision hips) hips which received hip arthroplasty during the observation period (1985~1998). We classified them according to the stability and the location of the fractures related to the stem tip: Proximal (I), middle (around stem) (II) and distal (III). Then we subclassified the fractures as cortical perforation or a fissure, undisplaced (A), displaced (B) and unstable prosthesis (C). we managed periprosthetic fracture with splint applied or cerclage proximal fracture (type I), plate fixation and bone grafts in the stem tip (type II) or distal fracture (type III). In unstable fractures, we revised them with long fluted stems.
RESULT
The average union time is 3.1 months (range, 2~6.2 months). After management of fracture with plate showed 5 complications, two nonunion and three refractures. The causes of nonunion are early weight bearing and a too short plate. The causes of refracture are screw fixation and empty hole just distal to stem tip. The other caused by the roles of stress riser in proximal screw of blade plate in management of supracondylar fracture.
CONCLUSION
We recommend the use of cerclage band system or fixed in a more proximal site in long plate and bone graft. In unstable prosthesis, we had taken a best results after revised with distal fluted stem, in which we don't need further distal stability like a additional cerclage or locking screw and additional bone graft.

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Treatment of Periprosthetic Fracture Following Total Elbow arthroplasty: Myung Chul Yoo, Yong Girl Rhee, Yoon Je Cho, Kang Il Kim, Young Lin Cho; J Korean Soc Fract 2000;13(1):193-199. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.193

Abstract PDF

PURPOSE
: To classify the pattern of periprosthetic fracture after total elbow replacement(TER) and introduce the principles of treatment in various fracture patterns.
MATERIALS AND METHODS
: Four patients(1 man and 3 women) were evaluated, who had periprosthetic fractures following total elbow arthroplasty, form July 1997 to October 1998. The incidence of fracture among TERs was 6%(4/62) and the average follow-up period was 1 year 6 months. The locations of periprosthetic fractures were classified according to Hanyu et al. The result were analyzed about the treatment modalities, the period to bony union, elbow motion and complication.
RESULTS
: Type2 and type 3 fractures were treated with closed reduction and hanging splint, whereas type 1 fracture showing loosening of humeral component was treated with revision arthroplasty. Type 4 fracture was treated with open reduction and internal fixation. The period to bone union was 5 months in average. The elbow motion ranged between 7.5degrees to 106.2degrees at the last follow-up. Type 3 showed anterior angulation deformity of 20degrees.
CONCLUSION
: Fracture pattern, stability, and loosing of component should be considered to select treatment modality. In transverse fracture proximal to the humeral stem tip(type 3), open reduction and internal fixation is recommended because of difficulties in maintaining alignment of fracture fragment. Postoperative rehabilitation program is very important to prevent limitation of elbow motion

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Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty
Hyunseok Seo, Jin-Hyung Im, Joo-Yup Lee
Journal of the Korean Fracture Society.2020; 33(2): 110. CrossRef

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Fractures of the Femur associated with the Hip Arthroplasty: Sung Kwan Hwang, Young Sang Lee, Jin Soo Park; J Korean Soc Fract 1999;12(4):837-843. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.837

Abstract PDF: Periprosthetic fractures as a complication of hip arthroplasty are uncommon. However, the incidence has been increafed recently especially in cementless or press-fit arthroplasties. The need to achieve a tight fit of the prosthesis in the bone when using cementless component has led to increased risk of periprosthetic fractures. We have experienced periprosthetic fractures occurred in 52 cases(51 patients) among 814 hip arthroplastic from January 1990 to December 1997. Among the 52 cases of periprosthetic fractures, 5 cases were occurred in cemented femoral stem(5 cases among the total 236 cases of cemented femoral stem : 2.1%), and 47 cases were occurred in the cementless type of femoral stem(47 cases among the total 578 cases of cementless type of femoral stem : 8.1%). There were 43 cases of intraoperative fracture and the rest was occurred postoperatively. According to the Johannson classification, type I fractures were 28 cases, type II fractures were 20 cases, and type III fractures were 4 cases. In postoperative periprosthetic fractures, according to the Vancouver classification, type A fracture was 1 case, typeB 1 fractures were 4 cases, typeB2 fractures were 2 cases, and type C fractures were 2 cases. The accurate preoperative templating and prophylactic managemnet of the risk factors are important for reducing the incidence of periprosthetic fractures.

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