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Le Baron M, Battut T, Bégué T, Ehlinger M, Flecher X. Minimally invasive surgery of femoral periprosthetic fractures increases the rate of consolidation and decreases time to bone healing without a higher rate of complications. Orthop Traumatol Surg Res 2024:103866. [PMID: 38460917 DOI: 10.1016/j.otsr.2024.103866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Knee periprosthetic femoral fractures (KPPFF) are becoming more frequent due to the increasing number of arthroplasties and the aging population, for whom maintaining autonomy and function remains a challenge. The use of locking plates has improved functional results and promoted the development of "minimally invasive" surgical (MIS) approaches. Despite the availability of literature comparing between different types of osteosynthesis for KPPFF, there is a paucity of information available on the complications of osteosynthesis using locking plates, depending on the approach. We therefore carried out a retrospective multicenter study (nine centers: Dijon, Grenoble, Lille, Marseille, Nice, Paris, Saint-Étienne, Strasbourg, Colmar) as part of a Symposium of the French Society of Orthopedic Surgery and Traumatology (SOFCOT). Following osteosynthesis of KPPFF by locking plates carried out by a standard approach or by a minimally invasive approach (MIS), the objectives were: (1) to compare the complications, (2) to evaluate whether the radiological and clinical results (rate and time of consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy) were comparable in the two groups. HYPOTHESIS The hypothesis was that performing an MIS approach in these indications does not confer more complications than a standard approach, and rather, the MIS approach offers better functional and radiological results. MATERIAL AND METHOD Five hundred and seventy-three patients presented with KPPFF over the periods studied (retrospective series from January 2012 to December 2016, then prospective series from January to December 2019). After applying the inclusion criteria (KPPFF by locking plate) and exclusion criteria (tumor context, infectious, intraoperative fractures, fractures on loose prostheses, other osteosynthesis methods, treatment by prosthetic revision, patients under the age of 18, follow-up less than 1-year, incomplete files), a global series of 306 patients was retained. Two groups were created according to the approach performed: a standard approach group (S, n=228) and a minimally invasive approach group (MIS, n=78). The demographic data of the population were recorded, as was the criteria for autonomy (Parker score, place of living). Postoperative complications were sought (infection, mechanical complication, surgical revision). Finally, the radiological and clinical results were evaluated (rate of, and time to consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy). RESULTS The comparison of the two subgroups, S and MIS, found complication rates are comparable in the two groups in terms of infections [S group: n=18 (7.9%), MIS group: n=2 (2.6%)], mechanical complications [S: n=23 (10.1%), MIS: n=2 (2.6%)], and surgical revision [S: n=33 (14.5%), MIS: n=7 (8.9%)], and a lack of difference in postoperative autonomy [Parker; S group: 4.7±2.4 (0-9) vs. MIS group: 5±2, 7 (0-9)]. On the other hand, the time to return to weight bearing was shorter in the MIS group [4.3±3.5weeks (0-12) versus 10.1±10.1weeks (0-110), p<0.001]. The rate of nonunion was lower in the MIS group [n=1 vs. n=20, i.e. 1.7% vs. 11.1% (p=0.031)] and the time to consolidation was shorter [7.5±4.3weeks (6-30) versus 15.2±9.4weeks (5-78) (p<0.001)]. CONCLUSION Performing an MIS approach in the management of KPPFF by locking plate osteosynthesis does not cause any more complications than a standard approach. In addition, higher consolidation rates can be obtained in shorter periods of time. This study suggests that it proposing osteosynthesis using the MIS approach as a primary surgery is a reasonable choice when treatment using locking plates is chosen for a KPPFF, subject to technical expertise. LEVEL OF EVIDENCE III; observational study.
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Affiliation(s)
- Marie Le Baron
- Service de chirurgie orthopédique, hôpital Nord, pôle locomoteur, Institut du mouvement et de l'appareil locomoteur, Assistance publique-Hôpitaux de Marseille, Marseille, France; Institut du mouvement et de l'appareil locomoteur, Assistance publique-Hôpitaux de Marseille, Marseille, France.
| | - Thibaut Battut
- Hôpital d'instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Thierry Bégué
- Service de chirurgie orthopédique et traumatologique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre 2, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Xavier Flecher
- Institut du mouvement et de l'appareil locomoteur, département d'orthopédie et de traumatologie ISM, CNRS, Aix-Marseille université, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France; Institut du mouvement et de l'appareil locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France
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Rao BM, Stokey P, Tanios M, Liu J, Ebraheim NA. A systematic review of the surgical outcomes of interprosthetic femur fractures. J Orthop 2022; 33:105-111. [PMID: 35958982 PMCID: PMC9357707 DOI: 10.1016/j.jor.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Interprosthetic femur fractures (IFFs) are rare, but the treatment is challenging. Currently, there are many treatment methods used in practice, but an updated systematic review of comparison of common different surgical outcomes has not been thoroughly inspected. Methods A systematic review of retrospective studies was conducted. The resource databases of PubMed, Cochrane, and Embase were searched using a combination of the keywords involving IFFs and surgical outcomes from inception through June 2021. Data collected included patient demographics, intraoperative data, and postoperative outcomes. Outcomes were measured based on healing time, revision rate, complication rate, and functional scores. Results Forty studies were included for review with a total of 508 patients. Average reported age of patients was 78.7 years old and 403 (79.3%) were females. Overall union rate was 74.0% with 376 of 508 patients achieving fracture union after primary treatment of IFF. Only 271 patients had reported healing times of fractures with a mean of 5.15 months. The plate, prosthetic revision, nail/rod, and external fixator groups had mean healing times of 4.69, 8.73, 6.5, and 5.1 months, respectively. Revision rates were highest in the femur replacement treatment group with 9 (32.1%) patients needing at least one reoperation surgery for any reason. Overall, hardware failure and non-unions were the most reported complications in treatment of IFFs. Postoperative functional outcome scores were available for 242 patients. Harris Hip Scores for the plate, revision, replacement, nail/rod, and plate + revision groups were 76.84, 77.14, 69.9, 77, and 78.4, respectively. Conclusion Each treatment method should be carefully considered by the surgeon depending on the patient. Locking plate was the most common method for the treatment of the patients with IFFs. Half of them combined with cerclage wires/cables. Around two thirds' patients could achieve union with the fastest mean healing time around 4.69 months. Other less common methods included prosthetic revision, femur replacement, nail/rod, external fixator, etc. A small number of patients treated with Ilizarov external fixator, and it has proven to be a viable option with few complications and high union rates.
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Affiliation(s)
- Brian M. Rao
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Phillip Stokey
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Mina Tanios
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Jiayong Liu
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Nabil A. Ebraheim
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
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Bonnomet F, Favreau H, Bonnevialle P, Adam P, Ehlinger M. Interimplant femoral fractures. Orthop Traumatol Surg Res 2022; 108:103117. [PMID: 34666198 DOI: 10.1016/j.otsr.2021.103117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
The number of hip or knee arthroplasties, and internal fixations of the proximal and distal femur, is increasing in proportion to the growing and ageing population, whose life expectancy is lengthening. Thus, fractures of the femur between proximal and distal implants, although rare, are becoming more frequent. Women over the age of 70, with fragile bones and whose ends of the two implants are close to each other ("kissing implants") are particularly vulnerable to them. Reliable and reproducible fracture classifications exist when it comes to 2 prostheses, but they are less well established in the presence of one, or even two, non-prosthetic implants. Their treatment is difficult and must consider the possibility of fracture consolidation while ensuring or restoring the stability and role of the implants. Whether it is the main element of treatment or a complement to prosthesis revision, locked plating forms the basis of the treatment but it must be rigorous, considering that failures are mainly the result of technical errors. Other more invasive treatments (total femoral arthroplasty, cortical sleeves) are offered more rarely if consolidation appears compromised.
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Affiliation(s)
- François Bonnomet
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France.
| | - Henri Favreau
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital Paul-Riquet, place Baylac, 31052 Toulouse, France
| | - Philippe Adam
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - Matthieu Ehlinger
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
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Townsend O, Jain S, Lamb JN, Scott CEH, Dunlop DG, Pandit HG. Periprosthetic femoral fracture type and location are influenced by the presence of an ipsilateral knee arthroplasty implant: A case-control study of 84 interprosthetic femoral fractures. Injury 2022; 53:645-652. [PMID: 34893307 DOI: 10.1016/j.injury.2021.11.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/13/2021] [Accepted: 11/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This multicentre case-control study compares Vancouver Classification System (VCS) grade and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture type in interprosthetic femoral fractures (IPFFs) between primary total hip arthroplasty (THA) and ipsilateral total knee arthroplasty (TKA) to periprosthetic femoral fracture (PFF) without ipsilateral TKA. METHODS Data were collected following institutional approval. Eighty-four IPFFs were assessed for VCS grade and AO/OTA type. Each IPFF case (84) was matched to five PFF controls (360) by age, gender and stem fixation philosophy (SMD<0.1). VCS grade and AO/OTA type were compared between the IPFF and PFF groups using weighted proportions and medians. RESULTS Median (IQR) age of IPFF patients was 81.75 (76.57-85.33) years and 61 (72.6%) were female. The commonest VCS grade was B1 (34, 40.5%). The commonest AO/OTA type was spiral (51.8% of VCS B fractures; 50.0% of VCS C fractures). A greater proportion of fractures occurred distal to the stem in IPFF patients versus PFF patients (33.3% versus 18.2%, p = 0.003). VCS grade was significantly different between groups (p = 0.015). For VCS C fractures, twice as many AO/OTA transverse and wedge fractures occurred in the IPFF group compared to the PFF group (25.0% versus 12.6% and 7.1% versus 3.3%, respectively) although the overall difference was not statistically significant (p = 0.407). CONCLUSION The presence of an ipsilateral TKA affects the location of PFF with more fractures occurring distal to the stem. A greater proportion of bending type fractures occurred when an ipsilateral TKA was present. These unstable fractures often require more complex surgery.
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Affiliation(s)
- Oliver Townsend
- University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.
| | - Sameer Jain
- University of Leeds, Woodhouse, Leeds LS2 9JT, UK; Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, UK
| | - Jonathan N Lamb
- University of Leeds, Woodhouse, Leeds LS2 9JT, UK; Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, UK
| | - Chloe E H Scott
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Rd, Edinburgh EH16 4SA, Scotland, UK
| | - Douglas G Dunlop
- University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK; University of Southampton, University Rd, Highfield, Southampton SO17 1BJ, UK
| | - Hemant G Pandit
- University of Leeds, Woodhouse, Leeds LS2 9JT, UK; Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, UK
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Early experience with the use of trochanteric reattachment plate for the treatment of Vancouver type B 1 periprosthetic hip fractures. J Clin Orthop Trauma 2021; 23:101644. [PMID: 35070683 PMCID: PMC8758910 DOI: 10.1016/j.jcot.2021.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of our study is to study the usefulness of trochanteric reattachment plate in the management Vancouver type B 1 periprosthetic femur fractures. METHODS We describe a case series of 15 (12 F: 3 M) Vancouver type B 1 fracture fixed with trochanteric reattachment plate with 3 years follow up. Patients with Vancouver A, B2, B3 and C fractures were excluded in the study. Clinical and radiological assessment of patients was done at 1, 3, 6, 9, 12, 24 and 36 months. The parameters evaluated were fracture union, Harris hip score and post-operative complications if any. RESULTS Patients mean age was 74 years (range 58-84). Eleven patients were operated with cemented hemiarthroplasty while 4 patients had total hip arthroplasty done before. Operation time mean was 137.2 min and mean surgical blood loss was 522.66 ml. All the patients achieved radiological union of the fracture at mean of 14.13 weeks. Mean Harris hip Score was 82 at 36 months follow up. 13 out of 15 hips (86.67%) showed good clinical results and 2 patients (13.33%) showed fair result. All the patients returned to their pre injury activities of daily living. CONCLUSION Operative fixation of Vancouver type B 1 periprosthetic fractures is a challenge for an orthopedic surgeon. Open reduction and internal fixation of these fractures using of trochanteric reattachment plate incorporating screws and cerclage wires through the plate provides good outcome in these patients. Use of this plate offers the surgeon stability against shearing as well as rotational forces.
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Gausden EB, Tibbo ME, Perry KI, Berry DJ, Yuan BJ, Abdel MP. Outcomes of Vancouver C Periprosthetic Femur Fractures. J Arthroplasty 2021; 36:3601-3607. [PMID: 34119395 DOI: 10.1016/j.arth.2021.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Periprosthetic femur fractures (PFFs) that occur distal to a total hip arthroplasty, Vancouver C fractures, are challenging to treat. We aimed to report patient mortality, reoperations, and complications following Vancouver C PFFs in a contemporary cohort all treated with a laterally based locking plate. METHODS We retrospectively identified 42 consecutive Vancouver C PFFs between 2004 and 2018. There was a high prevalence of comorbidities, including 9 patients with neurologic conditions, 9 with a history of cancer, 8 diabetics, and 8 using chronic anticoagulation. Mean time from total hip arthroplasty to PFF was 6 years (range 1 month to 25 years). All fractures were treated with a laterally based locking plate. Fixation bypassed the femoral component in 98% of cases and extended as proximal as the lesser trochanter in 18%. Kaplan-Meier survival was used for patient mortality, and a competing risk model was used to analyze survivorship free of reoperation and nonunion. Mean follow-up was 2 years. RESULTS Patient mortality was 5% at 90 days and 31% at 2 years. Cumulative incidence of reoperation was 13% at 2 years. There were 5 reoperations including revision osteosynthesis for nonunion and/or hardware failure (2), debridement and hardware removal for infection (2), and removal of hardware and total knee arthroplasty for post-traumatic arthritis (1). Cumulative incidence of nonunion was 10% at 2 years. CONCLUSION Patients who sustained a Vancouver C PFFs had a high mortality rate (31%) at 2 years. Moreover, 13% of patients required a reoperation within 2 years, most commonly for infection or nonunion.
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Affiliation(s)
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Brandon J Yuan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Loucas M, Loucas R, Akhavan NS, Fries P, Dietrich M. Interprosthetic Femoral Fractures Surgical Treatment in Geriatric Patients. Geriatr Orthop Surg Rehabil 2021; 12:21514593211013790. [PMID: 34017616 PMCID: PMC8114290 DOI: 10.1177/21514593211013790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence Level III, Therapeutic study.
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Affiliation(s)
- Marios Loucas
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland.,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nico Safa Akhavan
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
| | - Patrick Fries
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
| | - Michael Dietrich
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
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Patsiogiannis N, Kanakaris NK, Giannoudis PV. Periprosthetic hip fractures: an update into their management and clinical outcomes. EFORT Open Rev 2021; 6:75-92. [PMID: 33532088 PMCID: PMC7845569 DOI: 10.1302/2058-5241.6.200050] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The Vancouver classification is still a useful tool of communication and stratification of periprosthetic fractures, but besides the three parameters it considers, clinicians should also assess additional factors. Combined advanced trauma and arthroplasty skills must be available in departments managing these complex injuries. Preoperative confirmation of the THA (total hip arthroplasty) stability is sometimes challenging. The most reliable method remains intraoperative assessment during surgical exploration of the hip joint. Certain B1 fractures will benefit from revision surgery, whilst some B2 fractures can be effectively managed with osteosynthesis, especially in frail patients. Less invasive osteosynthesis, balanced plate–bone constructs, composite implant solutions, together with an appropriate reduction of the limb axis, rotation and length are critical for a successful fixation and uneventful fracture healing.
Cite this article: EFORT Open Rev 2021;6:75-92. DOI: 10.1302/2058-5241.6.200050
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Affiliation(s)
| | - Nikolaos K Kanakaris
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds, UK.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
| | - Peter V Giannoudis
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds, UK.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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Anthropometric Factors on Safe Distances between Popliteal Vessels to the Femur for Cerclage Wiring of the Distal Femoral Fracture: A Magnetic Resonance Imaging Study. ACTA ACUST UNITED AC 2020; 56:medicina56120655. [PMID: 33260736 PMCID: PMC7761162 DOI: 10.3390/medicina56120655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022]
Abstract
Background and Objectives: The proximity of the popliteal vessels in the distal femur may increase the risk of iatrogenic vascular injury during cerclage wiring. In this study, the closest location and distance of the popliteal vessels to the femur was examined using magnetic resonance imaging (MRI). The associations between anthropometric factors and the distance that would guide the placement of wires safely during surgery were also identified. Materials and Methods: We reviewed adult knee magnetic resonance images and recorded: (1) the relation and the shortest horizontal distance (d-H) from the femoral cortex to the popliteal vessels in axial images and (2) the vertical distance (d-V) from the adductor tubercle to the axial level of the d-H values in coronal images. The effects of anthropometric factors (sex, age, body height, body weight, body mass index, thigh circumference, femoral length and femoral width) on these distances were analysed. Results: Analysis of 206 knee magnetic resonance images revealed that the closet locations of popliteal vessels were at the posteromedial aspect of the femur. The d-H and d-V were 7.38 ± 3.22 mm and 57.01 ± 11.14 mm, respectively, and were both shorter in women than in men (p < 0.001). Multivariate analysis identified thigh circumference and femoral length as the most influential factors for the d-H and d-V, respectively (p < 0.001). Linear regression demonstrated a strong positive linear correlation between the thigh circumference and the d-H and between the femoral length and the d-V (Pearson’s r = 0.891 and 0.806, respectively (p < 0.001)). Conclusions: The closet location and distance of the popliteal vessels to the femur provide useful information for wire placement during distal femoral fracture surgery while minimising the risk of vascular injury. Given that patients with a smaller thigh circumference and a shorter femoral length are more likely to have a smaller d-H and a shorter d-V, respectively, cautious measures should be taken in such cases.
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Beeres FJP, Emmink BL, Lanter K, Link BC, Babst R. Minimally invasive double-plating osteosynthesis of the distal femur. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:545-558. [DOI: 10.1007/s00064-020-00664-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/26/2019] [Accepted: 04/22/2019] [Indexed: 11/27/2022]
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Rozell JC, Delagrammaticas DE, Schwarzkopf R. Interprosthetic femoral fractures: management challenges. Orthop Res Rev 2019; 11:119-128. [PMID: 31572021 PMCID: PMC6754334 DOI: 10.2147/orr.s209647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022] Open
Abstract
Interprosthetic femur fractures are a rare but serious complication following total hip and knee arthroplasty. Classification systems have focused not only on diagnosis but also on treatment algorithm. Critical to the evaluation of patients with these fractures are an assessment of fracture location, bone quality, and the presence of stemmed implants. The gold standard for fracture fixation is locked plating with bicortical and unicortical screws, supplemented with wires or cables as needed. For patients with compromised bone stock or insufficient bony area for fixation, allograft augmentation with struts or interprosthetic sleeves may be used. For fractures with severe bone loss, conversion to a megaprosthesis or total femur replacement may be warranted.
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Affiliation(s)
- Joshua C Rozell
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | | | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
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Ehlinger M, Soenen M, Bahlouli N, Bonnevialle P. Interprosthetic femoral fracture: Crime or punishment? Orthop Traumatol Surg Res 2019; 105:577-578. [PMID: 30885817 DOI: 10.1016/j.otsr.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Matthieu Ehlinger
- Pôle Locomax, service de chirurgie orthopédique et de traumatologie du membre inférieur, hôpital de Hautepierre II, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Équipe MMB, laboratoire ICube, 300, boulevard Sébastien-Brant, 67400 Illkirch, France.
| | - Marc Soenen
- Polyclinique du Parc, avenue des Sables, 49300 Cholet, France
| | - Nadia Bahlouli
- Équipe MMB, laboratoire ICube, 300, boulevard Sébastien-Brant, 67400 Illkirch, France
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital PP Riquet, place Baylac, 31052 Toulouse cedex, France
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Bonnevialle P, Marcheix PS, Nicolau X, Arboucalot M, Lebaron M, Chantelot C, Mainard D, Ehlinger M. Interprosthetic femoral fractures: Morbidity and mortality in a retrospective, multicenter study. Orthop Traumatol Surg Res 2019; 105:579-585. [PMID: 30514624 DOI: 10.1016/j.otsr.2018.07.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Interprosthetic femoral fractures (IFF) are becoming more frequent; however they have not been the subject of many publications and the largest study on this topic includes only 30 cases. The complication rate and clinical outcomes have only been evaluated in small case series. This led us to conduct a retrospective, multicenter, observational study in IFF patients with at least 12 months' follow-up to (1) determine the mortality and morbidity (2) determine the clinical and radiological outcomes and (3) identify elements of the treatment indications. HYPOTHESIS The morbidity and mortality rates will be comparable to those in recent studies on this topic. MATERIALS AND METHODS The study included 51 patients (49 women, 2 men) with a mean age of 82.8±9.2 years [55-97], a mean Parker score of 4.9±2.4 and a mean Katz score of 4.4±1.4 who had suffered an IFF between 2009 and 2015. According to the SoFCOT modifications of the Vancouver classification, 30 fractures were interprosthetic in the shaft segment where there were no implants (19 double C and 11 type D (corresponding to a type C with less than two diaphysis widths between the extension stems of the hip and knee implants)) while 21 were periprosthetic, with 12 around the THA (11 B1 and 1 B3) and 9 around the TKA (8 B1 and 1 B3). One patient was treated conservatively with an external fixator but died the next day, 2 patients received a new total hip arthroplasty and 47 underwent plate fixation of their fracture (one patient was treated non-operatively because of poor medical condition). RESULTS One patient was lost to follow-up, and nine died during the first 6 months. Six early surgical site complications occurred and 13 general ones. Within 1 year of the IFF, there were six mechanical complications, two surgical site infections and two cases of loosening. The mean follow-up was 27.6±17.2 months. The mean time to union was 19.25±8.8 weeks. The mean final Parker score was 3.37±2.6 and the mean Katz score was 2.98±1.8; both were significantly lower than the initial scores. Six patients died between months 12 and 50. The overall mortality at the final review was 31% (16/51) with a median survival of 3.45 years. DISCUSSION Our hypothesis was not confirmed because the mortality and morbidity in our study were higher than in other published studies. In the six relevant studies identified, the surgical site infection rate was 12.3%, the major revision rate was 11.6% and the mortality rate was 6.5%. In our study, these values were 24%, 24% and 31%, respectively. These worse results may be explained by the very fragile nature of the studied population and the surgeons not following appropriate technical rules for fracture fixation. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse, France.
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et de traumatologie, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Xavier Nicolau
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - Marine Arboucalot
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse, France
| | - Marie Lebaron
- Service de chirurgie orthopédique et de traumatologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - Christophe Chantelot
- Service de chirurgie orthopédique et de traumatologie, place de Verdun, 59037 Lille, France
| | - Didier Mainard
- Service de chirurgie orthopédique et de traumatologie, hôpital central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
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- Groupe d'étude en traumatologie [French Orthopedic Trauma Society], 56, rue Boissonade, 75014 Paris, France
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Ehlinger M, Niglis L, Favreau H, Kuntz S, Bierry G, Adam P, Bonnomet F. Vascular complication after percutaneous femoral cerclage wire. Orthop Traumatol Surg Res 2018; 104:377-381. [PMID: 29414721 DOI: 10.1016/j.otsr.2017.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 02/02/2023]
Abstract
Cerclage wire is an effective fracture fixation method. However, its mechanical benefits are countered by local ischemia. Its efficacy for treating femoral periprosthetic fractures has been demonstrated since femoral fixation is possible even there is a stem in the diaphysis. It securely holds the proximal femur typically with an additional plate. The development of minimally-invasive surgery with plate fixation has led to the cerclage wire being inserted percutaneously. Here, we report on a case of secondary femoral ischemia following percutaneous cerclage wire of a periprosthetic femoral fracture. This was a Vancouver type B1 fracture. On the 3rd day after admission, minimally-invasive fixation with a femoral locking plate was performed with five cerclage wires added percutaneously. During the immediate postoperative course, the patient developed ischemia of the operated leg that required vascular surgery after confirmation by CT angiography. An arterial stop was visible with deviation of the superior femoral artery, which was not properly surrounded by the cerclage wire. The latter pulled perivascular tissues towards the femur. When combined with reduced arterial elasticity due to severe atherosclerosis, it resulted in arterial plication. The postoperative course was marked by multiple organ failure and death of the patient. Percutaneous surgery is an attractive option but has risks. The presence of severe atherosclerosis is a warning sign for loss of tissue elasticity. This complication can be prevented by preparing the bone surfaces and carefully positioning the patient on the traction table to avoid forced adduction. The surgeon must also be familiar with alternative techniques to cerclage wire such as polyaxial screws and additional plates.
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Affiliation(s)
- M Ehlinger
- Service de chirurgie orthopédique et traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
| | - L Niglis
- Service de chirurgie orthopédique et traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - H Favreau
- Service de chirurgie orthopédique et traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - S Kuntz
- Service de chirurgie orthopédique et traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - G Bierry
- Service de radiologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - P Adam
- Service de chirurgie orthopédique et traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - F Bonnomet
- Service de chirurgie orthopédique et traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
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Gavanier B, Houfani F, Dumoulin Q, Bernard E, Mangin M, Mainard D. Osteosynthesis of periprosthetic type A and B femoral fractures using an unlocked plate with integrated cerclage cable and trochanteric hook: A multicenter retrospective study of 45 patients with mean follow-up of 20 months. Injury 2017; 48:2827-2832. [PMID: 29100663 DOI: 10.1016/j.injury.2017.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral periprosthetic fracture (FPF) is a frequent complication in dependent elderly persons, with a limited life expectancy. Their management is difficult and the choice between osteosynthesis and prosthesis is still matter of discussion. To date, there is no study on unlocked plate with integrated cerclage cable and trochanteric hook for this indication. The objectives of this study were to analyze fracture healing, complication rate and functional outcome. Our hypothesis is that this technique allows a high rate of consolidation and a return to the previous state in terms of autonomy and place of residence. MATERIALS AND METHODS We conducted a retrospective multicenter study between 2010 and 2015. The inclusion criteria were: patients with type A and B FPF according to the classification of Vancouver who received osteosynthesis hook plate. The evaluation focused on the consolidation period, complications and pre and postoperative Parker and Katz scores. Death, nonunion, dislocation, infection and failure of fixation were considered major complications. RESULTS Forty-five patients met the inclusion criteria and were evaluated at mean 20 months (6-72). All fractures consolidated at a mean 7 weeks (6-10), except one that has not undergone further surgery in the absence of functional impairment. Parker score decreased from 6.4 to 4.9 (p=0.03) and Katz score from 4.8 to 4.3 (p=0.045). Five patients died within the year of the operation. Five patients living at home preoperatively were admitted to an institution, the others returned to their retirement home or nursing home. CONCLUSION This plate allows for a quick and effective management of patients with FPF. The low rate of complications and the very good consolidation rate lead us to use the same plate even for class B2 or B3 fractures in some patients with precarious health condition who cannot tolerate major revision surgery: Elderly, ASA score >3, loss of autonomy, Katz score <4.
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Affiliation(s)
- B Gavanier
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - F Houfani
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - Q Dumoulin
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - E Bernard
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - M Mangin
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
| | - D Mainard
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
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Abstract
Femoral fractures between a total hip arthroplasty prosthesis and total knee arthroplasty prosthesis, also called interprosthetic fractures, are challenging clinical problems. The number of patients who have undergone ipsilateral primary or revision joint arthroplasty procedures in both the hip and the knee continues to rise, and the number of interprosthetic fractures is increasing, as well. The growing body of biomechanical and clinical literature on interprosthetic fractures reflects the increased frequency of and interest in these injuries. Similar to the management of periprosthetic fractures, the management of interprosthetic fractures depends on the location of the fracture, the stability of the implant, and the ability to achieve stable fracture fixation. These factors are the basis of recently described classification systems and treatment strategies. In patients with stable implants, fracture fixation alone is performed. When the implant is loose, both revision arthroplasty and fracture fixation may be required to provide stability of the limb.
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Albareda J, Gómez J, Ezquerra L, Blanco N. Interprosthetic femoral fractures: Treatment with a lateral angular-stable plate. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Interprosthetic femoral fractures: Treatment with a lateral angular-stable plate. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 61:1-7. [PMID: 27818190 DOI: 10.1016/j.recot.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 07/12/2016] [Accepted: 09/20/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To study the causes and outcomes of patients with interprosthetic femoral fractures. MATERIAL AND METHODS A retrospective review conducted on 7 patients treated between 2010 and 2013. The knee arthroplasties had been implanted for at least 5 years, and those of the hip less than a year. They were bipolar cemented in 6 patients and totally non-cemented in one patient, all of them implanted due to a displaced femoral neck fracture. They were treated using osteosynthesis with angular stability plate covering the whole interprosthetic femoral segment. Except for one patient, all have been reviewed at least 12 months. RESULTS The patients included 6 women and one man, with a mean age of 84.7. The fracture, always by low energy, occurred between 2 and 8 months after that of the hip without the implants being mobilized. Four of them were located at diaphyseal level, and 3 at supracondylar level, and unrelated to the type of knee implant. There was consolidation in all patients at a mean of 4.5 months, without a re-operation in any of them, and with no mortality during the follow-up period. All patients walked independently at the time of the fracture, and all of them have managed to return to walking independently, having lost as average 20° of knee flexion in cases of supracondylar fracture. CONCLUSIONS The most important factors in our patients regarding the producing of the fracture have been the changes in the ability to walk after knee replacement and bone fragility. Angular stability plates give good results in the treatment of interprosthetic femoral fractures.
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Outcome of periprosthetic femoral fractures following total hip replacement treated with polyaxial locking plate. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:107-112. [PMID: 27600334 DOI: 10.1007/s00590-016-1851-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The number of patients with total hip replacement (THR) is likely to grow. Periprosthetic femoral fractures occur in 0.1-4.5 % of patients with THR. Treatment of periprosthetic fractures in the vicinity of well-fixed implants has focused on lateral plating. The purpose of this study was to evaluate polyaxial locking plate treatment of periprosthetic fractures with THR in regard to fracture type, surgical procedure, complications, and outcome. METHODS Between 2007 and 2013, 109 patients underwent surgical treatment for periprosthetic femur fractures with 66 fractures in the vicinity to a THR. Fifteen patients were excluded. Therefore, 51 patients with a mean age of 78.7 years were identified. There were 76.5 % females. Average BMI was 27.1 kg/m2. Follow-up averaged 25 months. Total hip stems were uncemented in 63 %. Low-energy mechanism predominated. Fractures were classified according to AO/OTA and Vancouver classifications with the majority (70.6 %) classified as AO/OTA type A fractures. Surgeries were performed utilizing a polyaxial locking plate. Complications were recorded concerning infection, union, fixation failure, and revision surgery. RESULTS After the index procedure, 90.2 % healed. Non-union formation was diagnosed in 5.9 % with 2.0 % leading to hardware failure. All patients with non-union formation had interprosthetic fractures (χ 2 = 0.016). Additionally, these fractures were classified as AO/OTA type B fractures (χ 2 = 0.003). CONCLUSIONS Surgical management despite polyaxial locked plate fixation continues to be challenging and may still result in non-union formation. Non-union formation is increased in AO/OTA type B fractures and related to interprosthetic fractures. LEVEL OF EVIDENCE Level IV.
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Lenz M, Stoffel K, Gueorguiev B, Klos K, Kielstein H, Hofmann GO. Enhancing fixation strength in periprosthetic femur fractures by orthogonal plating-A biomechanical study. J Orthop Res 2016; 34:591-6. [PMID: 26447634 DOI: 10.1002/jor.23065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/01/2015] [Indexed: 02/04/2023]
Abstract
Orthogonal plate osteosynthesis enhances fixation stability in periprosthetic femur fractures. Another option are locking attachment plates (LAP) allowing bicortical locking screw placement lateral to the prosthesis stem. Stability of lateral plate osteosynthesis with two LAP (2LAP) was compared to anterolateral orthogonal plate osteosynthesis (OP) with one LAP in a periprosthetic femur fracture model. In six pairs of fresh frozen human femora with cemented Charnley hip prosthesis, a transverse osteotomy was set distal to the tip of the prosthesis simulating a Vancouver type B1 fracture. Each pair was instrumented using a plate tensioner with either one lateral plate and two LAP, or two orthogonal anterolateral plates and one LAP. Stiffness was determined in a four-point-bending test prior to cyclic testing (2Hz) with physiologic profile and progressively increasing load up to catastrophic construct failure. Paired t-test and Wilcoxon-signed-rank test were used for statistical evaluation at a level of significance p = 0.05. The OP construct exhibited a significantly higher number of cycles and load to failure (39,627 cycles ± 4,056; 4,463 N ± 906) compared to the 2LAP construct (32,927 cycles ± 3,487; 3,793 N ± 849), p < 0.01. Mediolateral bending and torsional stiffness of the OP (1610 N/mm ± 249; 16.9 Nm/mm ± 6.3) were significantly higher compared to 2 LAP (1077 N/mm ± 189; 12.1 Nm/mm ± 3.9), p = 0.03 for both comparisons. Orthogonal plate osteosynthesis is a valuable option in periprosthetic fracture surgery, offering increased stability compared to a single lateral plate fixed with two LAP.
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Affiliation(s)
- Mark Lenz
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos Platz, Switzerland.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany
| | - Karl Stoffel
- Cantonal Hospital Baselland, Liestal, Switzerland.,University of Basel, Basel, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos Platz, Switzerland
| | - Kajetan Klos
- Department of Foot and Ankle Surgery, Catholic Hospital Mainz, Germany
| | - Heike Kielstein
- Department of Anatomy and Cell Biology, Martin-Luther-University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany
| | - Gunther O Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany
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Interprosthetic fractures of the lower extermity. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Distal femoral periprosthetic fractures are on the rise. Increased mortality of these injuries is also evident from recent data. Their incidence and risk factors have been extensively reported in the past but new data are being available that merit attention. The increased incidence and the even higher projected incidence should direct the focus of future strategies to the education of surgeons, relevant capacity of hospital and reconfiguration of health care resources. New and potentially modifiable risk factors should be taken into consideration to the informed consent process and new studies should be developed to clarify the causative relationship of the new risk factors such as the peptic ulcer disease and the COPD. The main internal fixation techniques remain the lateral locking plating and the retrograde intramedullary nailing. New techniques in plating are the supplementary medial plate in selected cases and the far cortical locking. Nailing is considered a valid option especially in fractures located well above the anterior flange of the femoral component of the arthroplasty. Results and outcomes from good quality studies are still sparse regarding the comparison between plating and nailing. Interprosthetic fractures constitute an entity that is lately gaining considerable attention. The best method of management of these injuries is still evolving with considerable amount of work being done in the clinical and biomechanical level.
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Affiliation(s)
- Theodoros H Tosounidis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK.
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Clinical and radiological results of patients treated with orthogonal double plating for periprosthetic femoral fractures. INTERNATIONAL ORTHOPAEDICS 2014; 38:2469-72. [PMID: 25109478 DOI: 10.1007/s00264-014-2464-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/08/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to determine the outcome of surgically-treated periprosthetic femoral fractures with an orthogonal double plate system. METHODS We performed a retrospective study of ten patients (mean age 79.5 years) surgically treated for periprosthetic femoral fractures using orthogonal double plating (lateral and additional anterior plate position) from 2010 to 2013. The patients' demographic characteristics, complications and initial follow-up data were retrieved from our institutional database. After a minimum of six months post-surgery, we performed a radiological and clinical follow-up. RESULTS The surgical indications for orthogonal plating were heterogenic; five patients were treated for periprosthetic fractures around their total hip prosthesis. One was treated for a fracture around a total knee prosthesis and one for an interprosthetic fracture. Additionally, three patients were treated for postoperative implant failure after the stabilisation of periprosthetic fractures around a total hip prosthesis (one) or total knee prosthesis (two). Osteosynthesis was performed using locking compression plates exclusively (length between eight and 20 holes). After a mean follow-up of 22.6 months (range, six to 42 months), two patients died, but their deaths were due to old age morbidity and were unrelated to the surgery. Surgical revision for implant failure was necessary for only one female patient due to a breakage of the lateral plate. In addition, no other failures, such as infection or non-union, were observed. At the time of follow-up, seven out of ten patients were mobile and subjectively satisfied in regards to their outcome. CONCLUSIONS Based on a small number of cases, we were able to show for the first time that the use of orthogonal double plating is not associated with an increased rate of complications in patients with periprosthetic femoral fractures and stable components. Moreover, orthogonal double plating can be used successfully as a salvage procedure. At the time of follow up, seven out of ten patients were mobile. More cases must be investigated to validate our findings.
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Interprosthetic femoral fractures treated with locking plate. INTERNATIONAL ORTHOPAEDICS 2014; 38:2183-9. [PMID: 25011409 DOI: 10.1007/s00264-014-2414-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Interprosthetic fractures are challenging to manage. Although treatment of femoral fractures around a single implant has been described, there is little literature for treatment of interprosthetic femoral fractures. This study analyses the management and outcomes of 15 patients with interprosthetic femoral fractures treated with locking plates. METHODS A retrospective chart review was conducted of 17 patients with interprosthetic femur fracture treated with locking plates from 2002 to 2013. Patient demographics and comorbidities were collected. Preoperatively, patients were classified with the Vancouver or Su classification system. Intraoperative use of bone graft and/or cerclage cables was also examined. Clinical and radiographic outcomes were evaluated for union, time to full weight bearing, return to preinjury level of activity, and pain assessed with visual analog scale (VAS). RESULTS There were 15 patients with interprosthetic fractures meeting criteria for this study. Average patient age was 80.53 (range, 61-92) years. Bone grafting was used in 23.5% (four of 17) and cerclage cables in 29.4% (five of 17). Patients achieved complete union and return to full weight bearing an average of 4.02 (range, two to six) months later. Average VAS pain score was 1.00 (range, zero to six). All patients returned to their preoperative ambulatory status. CONCLUSION Locking plates could achieve satisfactory results for interprosthetic fractures. Considering an individual's fracture type, bone quality and protheses to determine the appropriate plate length and optional use of cerclage and/or bone graft was essential. In this limited sample size, interprosthetic fractures occurred at similar rates at the supracondylar region and diaphysis.
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Minimally Invasive Plate Osteosynthesis in the Elderly Patient. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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