Intracapsular fracture of the proximal femur fracture after hip resurfacing treated by cannulated screws

Strategies for fixation of periprosthetic fragility fractures of the neck of femur below a well-functioning hip resurfacing arthroplasty: A case-series

Introduction

Metal-on-metal Hip Resurfacing (HR) was performed in many young individuals as it conserved bone stock and had low wear rates, before it became less popular due to the detection of Adverse Reactions to Metal Debris. As such, many patients in the community have well-functioning HRs and as they age, the incidence of fragility fractures of the neck of femur around the existing implant is expected to increase. These fractures are amenable to surgical fixation as adequate bone stock remains in the head of the femur and the implants are well fixed.

Case-series

We present a series of six cases which were treated by fixation using locked plates (3), dynamic hip screws (2) and cephalo-medullary nail (1). Four cases achieved clinical and radiographic union with good function. One case had a delayed union, though union was finally achieved at 23 months. One case had an early failure necessitating revision to a Total Hip Replacement after 6 weeks.

Discussion

We highlight the geometrical principles of placing fixation devices under an HR femoral component. We have also conducted a literature search and present details of all case reports to date.

Conclusion

Fragility per-trochanteric fractures under a well-fixed HR with good baseline function are amenable to fixation using a variety of methods including large screw devices that are commonly used in this location. Locked plates including variable angle locking designs should be kept available if needed.

Fixation and Implant Retention of Extracapsular Femoral Neck Periprosthetic Fractures Around Hip Resurfacing Arthroplasty - A Case Series

BACKGROUND

Extracapsular femoral neck fractures in the presence of a resurfacing hip arthroplasty (RHA) appear to be independent of suboptimal technique during the initial implantation of the RHA and present with a similar etiology as native hip fractures - that is, a fragility fracture related to pathological or age-related osteoporosis, as a consequence of trauma. In the presence of a well-fixed and previously well-functioning RHA, the options for management include revision arthroplasty or open reduction and internal fixation (ORIF). In the absence of loosening through mechanisms of wear, infection, metallosis, or suboptimal prosthesis positioning, many authors have advocated ORIF with implant retention. However, there is often debate regarding the use of total hip arthroplasty in these cases.

CASE SERIES

The authors conducted a thorough assessment of the literature followed by a retrospective review of outcomes for three patients treated by ORIF with implant retention for extracapsular femoral neck fractures around a RHA, using a standardized technique. All patients were independently mobile and active with well-fixed and well-functioning RHAs before the date of injury. All patients suffered low-energy trauma resulting in the fracture. There were no intraoperative or perioperative complications. All patients achieved full weight-bearing status and independent mobility. Two patients achieved radiographic union and returned to full range of movement and independent mobilization comparable to their preoperative state. One patient was lost to follow-up.

CONCLUSION

The authors believe that fixation of extracapsular proximal femoral fractures distal to a well-fixed, well-functioning RHA is a good management option in an independent and active patient. A higher level of evidence is needed to investigate the surgical management options of these injuries comparing osteosynthesis with revision arthroplasty.

Routine Fracture Fixation for a Periprosthetic Hip Fracture Below Birmingham Hip Resurfacing: A Case Report

CASE

We present a case of a 56-year-old man who sustained a basal cervical periprosthetic fracture around a well-fixed metal-on-metal hip resurfacing arthroplasty (MoMHRA). Although several fixation methods have been described, there seems to be no consensus about the optimal fixation method for fractures around MoMHRAs. This fracture could be regarded as a Vancouver type-B1 or -C periprosthetic fracture, so we successfully treated our patient in a standard way with a dynamic hip screw (DHS) and one cannulated hip screw.

CONCLUSION

We describe DHS fixation as a successful treatment option for periprosthetic hip fractures around well-fixed MoMHRA.

Stress Fracture of Proximal Femur after Hip Resurfacing Treated with Cannulated Screw

Stress fractures of the proximal femur are described in athletes and military personnel. In most cases, they are not treated surgically, except when they are at the top of the femoral neck and with cortical involvement. The return to sports is not recommended in patients with hip replacement, especially for the high rate of revision of implants in the younger patients. One of the major complications of hip resurfacing (HR) is the medial fracture of the femoral neck, which usually occurs within 9 weeks after surgery. The causes have to be attributed to a malposition of the femoral component or to an insufficient bone density. The case reported herein is unique because it describes a stress fracture on patient operated with HR, treated with screw fixation. Two years after surgery, the patient returned to his normal life, practicing sports, without progression of varus angulation of the stem.

Intertrochanteric Fracture after Hip Resurfacing Arthroplasty Managed with a Reconstruction Nail

Periprosthetic fractures after hip resurfacings are rare occurrences that can pose a challenge to orthopaedic surgeons. With hip resurfacings becoming more common, the prevalence of these fractures is likely to increase because these patients are usually younger and more active. We report a case of traumatic periprosthetic proximal femur fracture treated with a reconstruction intramedullary nail technique.

Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011

BACKGROUND

There is conflict of interest in the treatment of intracapsular femoral neck fractures and the outcomes. The aim of this study was evaluation the treatment outcomes of closed and open reduction and internal fixation with screw in 18-50-year-old patients.

MATERIALS AND METHODS

This clinical randomized study was conducted in Ayatollah Kashani Center in Isfahan from Nov 2010 to Nov 2011. In 42 patients selected in a randomized manner, fractures were reduced by closed reduction or open if necessary and C-ARM was controlled in AP and lateral plans. Movement range and femur pain severity were evaluated according to Visual analogue Scale (VAS) score at 3 and 6 months after surgery. Data were analyzed by SPSS 18. Chi-square, t-test, one-way analysis of variance (ANOVA), and descriptive statistics such as frequency distribution, mean, and mean deviation were used.

RESULTS

Forty-two patients with femoral neck fracture were treated by open [31 patients (73.8%)] or closed reduction [11 patients (26.2%)] and also osteosynthesis. Their mean age was 47.3 ± 9.8 years; 29 of them were males and 13 were females. Twelve patients had bad range of motion (ROM) (28.6%), 16 had intermediate ROM (38%), and 14 had good ROM (33.4%). After 6 months, 12 patients (28.6%) had bad ROM, 10 (23.8%) had intermediate ROM, and 20 (47.6%) had good ROM. There were 11 cases of non-union (35.5%) in the open reduction group and 4 in the closed group.

CONCLUSION

This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.

Periprosthetic fractures in the resurfaced hip--a case report and review of the literature

Traumatic periprosthetic fractures adjacent a hip resurfacing prosthesis are rare. When proximal fractures are encountered the obvious surgical solution is to revise to a large head stemmed femoral component. A previously well functioning implant may however be retained as various non-operative and operative treatment options exist. This paper reports the case history of a traumatic periprosthetic fracture successfully treated with cannulated screw fixation and reviews the current literature.

Successful fixation of an intertrochanteric fracture after hip resurfacing arthroplasty using cannulated screws

We report a case of successful treatment of a high, stable intertrochanteric fracture (type 1) in a 59-year-old man. He sustained the injury 8 years after the resurfacing procedure. The fracture was fixed using three 6.5-mm cannulated screws, and he has returned to his normal level of activities 8 months after the fixation. We have shown that fixation with cannulated screws may be an acceptable option for treatment of high trochanteric fractures where a stable anatomical reduction can be obtained. We have also included a review of the literature for other reported surgical treatment options of this complication.

Treatment of periprosthetic fractures around hip resurfacings with cephalomedullary nails

We describe 2 cases of proximal femoral fractures, 1 intertrochanteric and 1 subtrochanteric, distal to hip resurfacing implants that were managed successfully via internal fixation with trochanteric start point cephalomedullary nails. Both patients had pain-free, well-functioning implants with radiographically healed fractures at their 1-year follow-up. This novel approach offers several advantages over previously described techniques for these rare and difficult-to-treat fractures.

Intertrochanteric femoral fracture after hip resurfacing managed with a reverse distal femoral locking plate: a case report

Metal-on-metal hip resurfacing is a popular procedure for a select group of patients. A variety of surgical approaches are being utilised, each of which may be associated with specific complications. We describe an unusual complication following a Ganz trochanteric osteotomy approach, and the technique used to treat the subsequent periprosthetic fracture.