Fixation of Periprosthetic Femoral Shaft Fractures Associated With Cemented Femoral Stems

Fulkerson, Eric; Koval, Kenneth J.; Preston, Charles; Iesaka, Kazuho; Kummer, Frederick J.; Egol, Kenneth A

doi:10.1097/01.bot.0000199119.38359.96

Cited by 146 publications

(84 citation statements)

References 21 publications

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“…This problem is illustrated in figure. 5 . Different fixation methods were attempted and were frequently followed by unsatisfactory results [17] . In many studies, good results were reported with interlocked supracondylar nails if the implant allowed such an option ( fig.…”

Section: Discussionmentioning

confidence: 99%

“…Fixation methods include simple screws, cerclage wires, cable systems, ordinary plates alone or combined with strut graft and interlocking nails [10][11][12][13][14][15][16] . Recently developed locked plate systems are popular and very useful for periprosthetic fracture fixation [17,18] . In this report, we present our experience with the treatment of periprosthetic fracture of the femur after hip and knee replacements.…”

Section: Introductionmentioning

confidence: 99%

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Periprosthetic Fractures of the Femur after Hip and Knee Replacement

Pospula¹,

Noor²

2009

Med Princ Pract

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Objective: To present the clinical and radiological results of treatment of periprosthetic fractures of the femur after hip and knee replacements. Subjects and Methods: Thirty-four patients (8 males and 26 females) with 34 fractures of the femur complicating hip and knee replacements are the subjects of this report. In 21 cases, the fracture affected the femur after hip replacement, and in 13 cases after knee replacement. Fractures around the hip replacement were classified according to Vancouver classification, and those around the knee replacement were classified according to Rorabeck. Location of fracture was defined as metaphyseal or diaphyseal. Arbitrary classification of fracture union was used. Fractures were considered to be either united or to have delayed union, after radiology. Conservative treatment and different methods of fixation were used. Clinical correlations between location of fracture and outcome were analyzed. Results: All 21 metaphyseal fractures after hip and knee replacements united. Eight diaphyseal fractures (6 after hip replacement and 2 after knee replacement) united. Five diaphyseal fractures after hip replacement had delayed union, and 4 fractures united after bone graft. In 1 case, fracture did not unite, the treatment was discontinued and the patient was lost to follow-up. Conclusion: Our data show that metaphyseal fractures, regardless of type of implant, had better healing potential and did not require additional surgery. Diaphyseal fractures of the femoral shaft around the stem of femoral component of the hip or knee prosthesis required a bone graft and had less favorable outcomes. Women were more frequently affected by periprosthetic femoral fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Periprosthetic Fractures of the Femur after Hip and Knee Replacement

Pospula¹,

Noor²

2009

Med Princ Pract

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“…Locking plates demonstrate significantly increased stiffness as a biomechanical construct, however they exhibit catastrophic failure in terms of linear fracture between adjacent screw holes on the proximal cortex in cadaveric models, which is not observed with a cable plate construct [9]. Clinically, no benefit over conventional methods has been shown, with one series of fourteen patients experiencing six failures, with three plate fractures and three instances of fixation pull-out [10].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Review of the Dall-Miles Plate for Periprosthetic Femoral Fractures: Twenty-seven Cases and a Review of the Literature

Dargan¹,

Jenkinson²,

Acton³

2014

Injury

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“…As a result, placement with abutment of the prosthesis stem leading to altered screw threads with subsequent screw pullout or fatigue failure of the plate have been described [6][7][8]. Moreover, proximal screws may violate the bone-prosthesis interface, lead to formation of cement cracks with subsequent prosthetic loosening, act as stress enhancers with an increasing risk for further fractures, and cerclage fixation has shown high failure rates with minimal rotational stability [9][10][11][12]. For these reasons plates for extracortical fixation using the clamp-on principle have been developed.…”

Section: Introductionmentioning

confidence: 99%

Extracortical plate fixation with new plate inserts and cerclage wires for the treatment of periprosthetic hip fractures

Bastian

Butscher

Bigolin

et al. 2013

International Orthopaedics (SICOT)

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Purpose Fixation of periprosthetic hip fractures with intracortical anchorage might not be feasible in cases with bulky implants and/or poor bone stock. Methods Rotational stability of new plate inserts with extracortical anchorage for cerclage fixation was measured and compared to the stability found using a standard technique in a biomechanical setup using a torsion testing machine. In a synthetic PUR bone model, transverse fractures were fixed distally using screws and proximally by wire cerclages attached to the plates using "new" (extracortical anchorage) or "standard" (intracortical anchorage) plate inserts. Time to fracture consolidation and complications were assessed in a consecutive series of 18 patients (18 female; mean age 81 years, range 55-92) with periprosthetic hip fractures (ten type B1, eight type CVancouver) treated with the new device between July 2003 and July 2010. Results The "new" device showed a higher rotational stability than the "standard" technique (p <0.001). Fractures showed radiographic consolidation after 14±5 weeks (mean ± SD) postoperatively in patients. Revision surgery was necessary in four patients, unrelated to the new technique. Conclusion In periprosthetic hip fractures in which fixation with intracortical anchorage using conventional means might be difficult due to bulky revision stems and/or poor bone stock, the new device may be an addition to the range of existing implants.

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Fixation of Periprosthetic Femoral Shaft Fractures Associated With Cemented Femoral Stems

Abstract: Locked plating constructs were stiffer than the Ogden construct in axial loading and torsion. Although no differences in loads to failure during torsion were noted, locked plating constructs exhibited catastrophic failure not observed with the Ogden construct.

Cited by 146 publications

References 21 publications

Periprosthetic Fractures of the Femur after Hip and Knee Replacement

Periprosthetic Fractures of the Femur after Hip and Knee Replacement

A Retrospective Review of the Dall-Miles Plate for Periprosthetic Femoral Fractures: Twenty-seven Cases and a Review of the Literature

Extracortical plate fixation with new plate inserts and cerclage wires for the treatment of periprosthetic hip fractures

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