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Treatment of periprosthetic femoral fractures after femoral revision using a long stem
BACKGROUND: Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this st...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494722/ https://www.ncbi.nlm.nih.gov/pubmed/25958328 http://dx.doi.org/10.1186/s12891-015-0565-7 |
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author | Kim, Youngwoo Tanaka, Chiaki Tada, Hiroshi Kanoe, Hiroshi Shirai, Takaaki |
author_facet | Kim, Youngwoo Tanaka, Chiaki Tada, Hiroshi Kanoe, Hiroshi Shirai, Takaaki |
author_sort | Kim, Youngwoo |
collection | PubMed |
description | BACKGROUND: Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this study was to identify the clinical and radiographical features of periprosthetic femoral fractures after revision using a long stem. METHODS: We report a retrospective review of the outcomes of treatment of 11 periprosthetic fractures after femoral revision using a long stem. Eleven female patients with a mean age of 79.2 years (70 to 91) were treated for a Vancouver type B1 fracture between 1998 and 2013. The mean numbers of previous surgeries were 3.1 (2 to 5). RESULTS: The average follow-up was 58.9 months (8 to 180). We found several important features that might influence the outcome of treatment for periprosthetic femoral fractures after femoral revision using a long stem: 1) all cases were classified as Vancouver type B1. 2) 6 patients (55%) had a transverse fracture around the tip of the long stem. 3) 7 patients (64%) had a history of previous fracture of the ipsilateral femur. The type B1 fractures were treated with open reduction and internal fixation in 9 hips, 6 of which were reinforced with bone grafts. Two other periprosthetic fractures were treated with femoral revision. One was revised because of stem breakage, and the other was a transverse fracture associated with poor bone quality, which received a femoral revision with a long stem and a plate. All fractures except one achieved primary union. This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful. CONCLUSIONS: These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation. However, a transverse fracture with very poor bone quality might be considered as a type B3 fracture, and femoral revision might be a treatment of choice. |
format | Online Article Text |
id | pubmed-4494722 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-44947222015-07-08 Treatment of periprosthetic femoral fractures after femoral revision using a long stem Kim, Youngwoo Tanaka, Chiaki Tada, Hiroshi Kanoe, Hiroshi Shirai, Takaaki BMC Musculoskelet Disord Research Article BACKGROUND: Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this study was to identify the clinical and radiographical features of periprosthetic femoral fractures after revision using a long stem. METHODS: We report a retrospective review of the outcomes of treatment of 11 periprosthetic fractures after femoral revision using a long stem. Eleven female patients with a mean age of 79.2 years (70 to 91) were treated for a Vancouver type B1 fracture between 1998 and 2013. The mean numbers of previous surgeries were 3.1 (2 to 5). RESULTS: The average follow-up was 58.9 months (8 to 180). We found several important features that might influence the outcome of treatment for periprosthetic femoral fractures after femoral revision using a long stem: 1) all cases were classified as Vancouver type B1. 2) 6 patients (55%) had a transverse fracture around the tip of the long stem. 3) 7 patients (64%) had a history of previous fracture of the ipsilateral femur. The type B1 fractures were treated with open reduction and internal fixation in 9 hips, 6 of which were reinforced with bone grafts. Two other periprosthetic fractures were treated with femoral revision. One was revised because of stem breakage, and the other was a transverse fracture associated with poor bone quality, which received a femoral revision with a long stem and a plate. All fractures except one achieved primary union. This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful. CONCLUSIONS: These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation. However, a transverse fracture with very poor bone quality might be considered as a type B3 fracture, and femoral revision might be a treatment of choice. BioMed Central 2015-05-10 /pmc/articles/PMC4494722/ /pubmed/25958328 http://dx.doi.org/10.1186/s12891-015-0565-7 Text en © Kim et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Kim, Youngwoo Tanaka, Chiaki Tada, Hiroshi Kanoe, Hiroshi Shirai, Takaaki Treatment of periprosthetic femoral fractures after femoral revision using a long stem |
title | Treatment of periprosthetic femoral fractures after femoral revision using a long stem |
title_full | Treatment of periprosthetic femoral fractures after femoral revision using a long stem |
title_fullStr | Treatment of periprosthetic femoral fractures after femoral revision using a long stem |
title_full_unstemmed | Treatment of periprosthetic femoral fractures after femoral revision using a long stem |
title_short | Treatment of periprosthetic femoral fractures after femoral revision using a long stem |
title_sort | treatment of periprosthetic femoral fractures after femoral revision using a long stem |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494722/ https://www.ncbi.nlm.nih.gov/pubmed/25958328 http://dx.doi.org/10.1186/s12891-015-0565-7 |
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