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HOME > J Musculoskelet Trauma > Volume 33(1); 2020 > Article
Review Article Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty
Jung Hoon Choi, Jong Hyuk Jeon, Kyung Jae Lee
Journal of Musculoskeletal Trauma 2020;33(1):43-51.
DOI: https://doi.org/10.12671/jkfs.2020.33.1.43
Published online: January 31, 2020
Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea. dream21jh@naver.com

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Abstract

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.


J Korean Fract Soc. 2020 Jan;33(1):43-51. Korean.
Published online Jan 23, 2020.
https://doi.org/10.12671/jkfs.2020.33.1.43
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Review

Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty

Jung-Hoon Choi, M.D., Jong-Hyuk Jeon, M.D., and Kyung-Jae Lee, M.D.
    • Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.
  • Correspondence to: Jong-Hyuk Jeon, M.D. Department of Orthopedic Surgery, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-258-4770, Fax: +82-53-258-4773, Email: dream21jh@naver.com
Received January 04, 2020; Revised January 06, 2020; Accepted January 06, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords
Femur, Periprosthetic fracture, Hip arthroplasty, Vancouver classification

Figures

Fig. 1
(A) Preoperative radiograph and computed tomography scan show a periprosthetic femoral fracture after revision total hip arthroplasty. The surgeon decided the stem to be stable (Vancouver type-B1). (B) Indirect reduction with locking plate fixation was applied for this patient. Note that a locking attachment plate and cables were used for additional stability. (C) Postoperative radiograph at three months shows subsidence of the femoral stem (Vancouver type-B2).

Fig. 2
Anteroposterior radiographs of the femur obtained at prefracture (A) and post-fracture (B). Note that the distance between the tip of the greater trochanter and stem shoulder was increased after the periprosthetic fracture (stem subsidence). This implies the stem is unstable.

Fig. 3
(A) The preoperative radiograph shows periprosthetic femoral fracture. This stem is classified as type 1, which means it is a single-wedge proximal coated stem. Note that the fracture itself did not involve the proximal coating area. Open reduction and internal fixation with a locking plate (absolute stability) was applied (B) and the radiograph obtained at 5 years after fixation (C) shows a well-united fracture site and stable stem.

Fig. 4
Postoperative radiographs shows use of a blunt tip screw (arrow) to avoid cement mantle damage.

Fig. 5
(A) A 79-year-old female sustained a Vancouver type-AG fracture (arrows) after a fall. (B, C) A greater trochanteric fragment was displaced and recurrent dislocation had developed. (D) Open reduction and internal fixation with a claw plate was applied.

Fig. 6
Anteroposterior and lateral radiographs of the femur show a long looking plate was used for the Vancouver type-B fracture. Six unicortical screws and two cables were applied on the proximal femur for achieving sufficient stability.

Fig. 7
(A) Preoperative radiographs of the femur show a minimally displaced Vancouver type-B fracture. (B) Indirect reduction with plate osteosynthesis (relative stability) was used for the fixation.

Fig. 8
(A) Preoperative radiograph of the femur shows a Vancouver type-B2 fracture. (B) Postoperative radiograph shows revision of the femoral stem with using a prophylactic cable (arrow).

Fig. 9
(A) A 45-year-old male sustained a comminuted Vancouver type-C fracture after a traffic accident. (B, C) Minimally invasive plate osteosynthesis with a locking plate was used and the radiograph demonstrates good healing of the fracture.

Tables

Table 1
Vancouver Classification of the Postoperative Periprosthetic Femoral Fractures

Notes

Financial support:None.

Conflict of interests:None.

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    Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty
    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
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