Die periprothetische Fraktur

Grüner, A.; Hockertz, Thomas; Reilmann, H.

doi:10.1007/s00113-003-0698-2

Cited by 38 publications

(8 citation statements)

References 13 publications

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“…Fractures at the tip of the hip stem (Vancouver type B1) account for approximately one-third of periprosthetic proximal femur fractures [ 11 ]. These fractures occur owing to stress risers at the tip of the stem [ 12 ]. The LAP, which is attached to the LCP, (DePuy Synthes, Solothurn, Switzerland) was the first implant allowing bicortical screw placement around hip stems.…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic fracture fixation in Vancouver B1 femoral shaft fractures: A biomechanical study comparing two plate systems

Wähnert

Müller

Tiedemann

et al. 2020

Journal of Orthopaedic Translation

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Introduction Periprosthetic fractures of the femur are an increasing problem in today's trauma and orthopaedic surgery. Owing to the hip stem, implant anchorage is very difficult in the proximal femur. This study compares two plate systems regarding their biomechanical properties and the handling in periprosthetic fracture fixation of the proximal femur. Materials and methods Using eight pairs of fresh, frozen human proximal femora the Locking Compression Plate/Locking Attachment Plate construct (LCP/LAP) (group I, DePuy Synthes) was compared to the new LOQTEQ® periprosthetic distal lateral femur plate (group II, AAP Implantate AG). After implantation of press fit femoral hip stems a Vancouver B1 fracture model was used. Biomechanical testing was performed by cyclic axial loading with a constant increment of 0.1 N/cycle starting from 750 N axial loading. Every 250 cycles an a.p. x-ray was done to evaluate failure. Results The Group II showed significant higher axial stiffness (+42%) compared with Group I. In addition, Group II withstood significantly more load-cycles until failure (20%). The mode of catastrophic failure was plate breakage in Group II, whereas, in Group I, all plates showed an early bending followed by plate breakage. Discussion and conclusion Both plate systems enable screw placement around hip stems. The hinge plate showed superior biomechanical results compared with the locking compression plate/locking attachment plate construct. Furthermore, the hinge plate offers variable hinges and variable angel locking making bicortical screw placement around hip stems more comfortable and safe. The translational potential of this article The results of this study can be directly transferred to patient care. With the innovative hinge plate, the surgeon has a biomechanically superior implant, which also offers improved options for screw placement compared to a standard locking plate.

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Section: Discussionmentioning

confidence: 99%

Periprosthetic fracture fixation in Vancouver B1 femoral shaft fractures: A biomechanical study comparing two plate systems

Wähnert

Müller

Tiedemann

et al. 2020

Journal of Orthopaedic Translation

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“…Periprosthetic fractures in patient’s TKA show an incidence of 0.3–5.5% and after revision surgery even up to 6% [ 9 , 10 ]. However, data of most studies are of reduced significance due to their small number of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, these are serious diagnoses, which should be treated in centers with experienced orthopaedists and traumatologists. In general, the treatment of periprosthetic fractures requires an optimal combination of endoprosthetics and fracture care [ 9 , 12 , 17 ]. The aim in this is to restore the limb’s original functional capability for achieving a rapid recovery of mobility and to avoid complications like bedrest of the often multimorbid patients.…”

Section: Discussionmentioning

confidence: 99%

“…Besides endoprosthetic loosening, reduced bone quality through osteoporosis and physical impairment of geriatric patients with a tendency to fall are related to an increased periprosthetic fracture risk [ 7 , 8 ]. The incidence of PPF in knee prostheses varies between 0.6% and 5.5% in current literature [ 9 – 11 ]. For most of geriatric pre-disabled people PPF have serious consequences.…”

Section: Introductionmentioning

confidence: 99%

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A new classification of TKA periprosthetic femur fractures considering the implant type

Fakler

Pönick

Edel

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe treatment aims of periprosthetic fractures (PPF) of the distal femur are a gentle stabilization, an early load-bearing capacity and a rapid postoperative mobilization of the affected patients. For the therapy planning of PPF a standardized classification is necessary which leads to a clear and safe therapy recommendation. Despite different established classifications, there is none that includes the types of prosthesis used in the assessment. For this purpose, the objective of this work is to create a new more extensive fracture and implant-related classification of periprosthetic fractures of the distal femur based on available classifications which allows distinct therapeutic recommendations.MethodsIn a retrospective analysis all patients who were treated in the University Hospital Leipzig from 2010 to 2016 due to a distal femur fracture with total knee arthroplasty (TKA) were established. To create an implant-associated classification the cases were discussed in a panel of experienced orthopaedists and well-practiced traumatologists with a great knowledge in the field of endoprosthetics and fracture care. In this context, two experienced surgeons classified 55 consecutive fractures according to Su et al., Lewis and Rorabeck and by the new created classification. In this regard, the interobserver reliability was determined for two independent raters in terms of Cohen Kappa.ResultsOn the basis of the most widely recognized classifications of Su et al. as well as Lewis and Rorabeck, we established an implant-dependent classification for PPF of the distal femur. In accordance with the two stated classifications four fracture types were created and defined. Moreover, the four most frequent prosthesis types were integrated. Finally, a new classification with 16 subtypes was generated based on four types of fracture and four types of prosthesis. Considering all cases the presented implant-associated classification (κ = 0.74) showed a considerably higher interobserver reliability compared to the other classifications of Su et al. (κ = 0.39) as well as Lewis and Rorabeck (κ = 0.31). Excluding the cases which were only assessable by the new classification, it still shows a higher interobserver reliability (κ = 0.70) than the other ones (κ = 0.63 or κ = 0.45).ConclusionsThe new classification system for PPF of the distal femur following TKA considers fracture location and implant type. It is easy to use, shows agood interobserver reliability and allows conclusions to be drawn on treatment recommendations. Moreover, further studies on the evaluation of the classification are necessary and planned.

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“…[12] The incidence of periprosthetic humeral fractures after shoulder arthroplasty is rather low compared to the incidence of periprosthetic fractures around the hip or knee. [1314] Moreover, a functional deficit of the upper extremities becomes even more debilitating in elderly people after these injuries, as overall mobility is reduced.…”

Section: Discussionmentioning

confidence: 99%

Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures

Seybold

Citak

Königshausen

et al. 2011

Int J Shoulder Surg

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Operative treatment of periprosthetic humeral fractures in elderly patients with osteoporotic bone requires a stable fixations technique. The combination of 3.5 cortical screws with washers in a 4.5 Arbeitsgemeinschaft für Osteosynthesefragen, Limited-contact dynamic compression plate or Locking plate, allows a stable periprosthetic fixation with the small 3.5 screws and 4.5 screws above and below the prosthesis, respectively. This combination is a cost-effective technique to treat periprosthetic humeral fractures.

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Die periprothetische Fraktur

Cited by 38 publications

References 13 publications

Periprosthetic fracture fixation in Vancouver B1 femoral shaft fractures: A biomechanical study comparing two plate systems

Periprosthetic fracture fixation in Vancouver B1 femoral shaft fractures: A biomechanical study comparing two plate systems

A new classification of TKA periprosthetic femur fractures considering the implant type

Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures

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