Impaction Bone Grafting or Uncemented Modular Stems for the Treatment of Type B3 Periprosthetic Femoral Fractures? A Complication Rate Analysis

Dilernia, Fernando Díaz; Slullitel, Pablo; Oñativia, José Ignacio; Piccaluga, Francisco; Buttaro, Martín

doi:10.1016/j.arth.2019.04.047

Cited by 14 publications

(7 citation statements)

References 33 publications

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“…Diaz-Dilernia et al showed modular, distally fixed stems to be superior to impaction bone grafting (IBG) technique in treatment of Vancouver B3 periprosthetic fractures. 21 They found a significant association between surgical technique and complication rate with IBG having and odds ratio of 4.77 for IBG compared to modular stems.…”

Section: Discussionmentioning

confidence: 96%

Femoral revision for periprosthetic fracture in total hip arthroplasty

Menken

Rodríguez

2020

Journal of Clinical Orthopaedics and Trauma

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Periprosthetic fracture can create significant morbidity in the arthroplasty population. Patients with periprosthetic fracture have been shown to have worse outcomes and higher mortality than patients undergoing elective revision THA. In this review, we will focus on Vancouver B2 and B3 fractures. Both of these fracture types are associated with a loose primary prosthesis and warrant revision surgery. There are many different options for fixation choice of the femoral prosthesis, and preference has been evolving over the last 30 years. Currently, we use monoblock, tapered, fluted, titanium stems for all periprosthetic fracture revision surgeries.

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Section: Discussionmentioning

confidence: 96%

Femoral revision for periprosthetic fracture in total hip arthroplasty

Menken

Rodríguez

2020

Journal of Clinical Orthopaedics and Trauma

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“…Although bone grafting is recognized as an efficient, reliable, and promising orthopedic method, some studies have reported infectious complications associated with this procedure. In addition, bone grafting requires more operating time due to the determination of material, size, volume, and structure of graft appropriate to the defect (24)(25)(26). Conventionally, autologous bone is considered the optimal material since it is capable of meeting all necessary components including osteoconduction, osteoinduction, and osteogenesis of bone regeneration (27), and of avoiding histoincompatibility.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

Huang¹,

Guo²,

Zhu³

2021

Ann Palliat Med

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Background: To analyze the epidemiology and features of calcaneus osteomyelitis following open reduction and internal fixation (ORIF) after closed calcaneus fracture.Methods: We retrospectively analyzed 127 cases who were diagnosed with calcaneal osteomyelitis following ORIF via the extended lateral "L-shaped" approach after closed calcaneus fracture between March 2016 and August 2019 in our hospital. We analyzed participant demographics including gender, age, body mass index (BMI), trauma mechanism, Sanders classification, co-morbidity, time between initial injury and surgery, operating time, soft tissue stripping tools, tourniquet pressure, bone grafting option, internal fixation option, presence of bleeding after tourniquet deflation, and drainage option.Results: The majority of cases (n=127) were male (4.5 times more than female gender), at a ratio of 4.47:1.Falling from height was the main trauma mechanism (79.53%), followed by traffic accident (14.17%), and jumping (6.3%). A total of 51 cases (40.16%) were left-side fractures, and 76 (59.84%) were right-sided.According to the Sanders classification, 12 cases were type II (9.45%), 61 cases were type III (48.03%), and 54 cases were type IV (42.52%). There were 25 participants with the co-morbidity of type 2 diabetes mellitus (19.69%), 7 with hypertension (5.51%), and 1 case each of psoriasis and sicca syndrome (0.8%). The mean time to surgery was 4.7 days (4-9 days), and 123 participants (96.85%) were treated within 7 days. The mean operating time was 102.1 min (75-135 min). Forty-four participants (34.65%) received the conventional scalpel and 83 participants (65.35%) the electric scalpel during soft tissue stripping intraoperatively. The mean tourniquet pressure was 432.3 mmHg (350-550 mmHg). Autologous bone grafting was observed in 6 cases (4.72%), allograft bone grafting in 11 cases (8.67%), and OsteoSet grafting in 7 cases (5.51%).A locking plate was used in 114 cases (89.76) while anatomical plate in 13 cases (10.24%). A total of 27 participants (21.26%) bled after tourniquet deflation. Drainage tubes were applied in 30 participants (23.62%) while rubber drainage strips in 5 participants (3.94%).Conclusions: Young males dominated the calcaneus osteomyelitis following traumatic calcaneus fracture cohort in this study. A fall from height was the most frequent trauma mechanism. The presence of severe calcaneus fracture, Sanders type III (48.03%) and type IV (42.52%), were the common fracture types in this population group.

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“…, modular mega-prostheses)[ 17 ]. Each of these methods has unique advantages and limitations[ 17 - 19 ]. Standard modular prostheses are an available option for proximal femoral reconstruction in many cases and have been developed to be broadly applicable across several patient groups and fracture morphologies.…”

Section: Discussionmentioning

confidence: 99%

Total hip revision with custom-made spacer and prosthesis: A case report

Liu¹,

Pan²,

Chen³

et al. 2021

WJCC

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BACKGROUND Both periprosthetic joint infections (PJIs) and severe femoral segmental defects are catastrophic complications of total hip arthroplasty (THA), and both present a significant challenge in revisional surgery. There are limited data available to guide clinical decision making when both occur concurrently. CASE SUMMARY A 61-year-old woman presented with a 6-mo history of a sinus tract at the site of her original THA incision. Radiological imaging revealed a total hip joint implant with an ipsilateral segmental femoral defect. Based on histological, radiological, laboratory, and clinical features, a diagnosis of concurrent chronic PJI and segmental femoral defect (Type IIIB, Paprosky classification) was made. After multidisciplinary team discussion, three-dimensional (3D)-printed, custom-made antibiotic spacers were created that could be used to mold antibiotic-loaded cement spacer. These were placed following PJI debridement in the first stage of revision surgery. After the PJI was eliminated, a 3D-printed, custom-made, femoral prosthesis was created to repair the considerable femoral defect. After 20-mo follow-up, the patient had excellent functional outcomes with a near-normal range of hip movement. So far, neither evidence of recurrent infection nor loosening of the prosthesis has been observed. CONCLUSION We describe a case of “two-stage, custom-made” total hip revision to treat PJI with a concurrent segmental femoral defect. Use of a personalized, 3D-printed spacer and proximal femoral prosthesis led to satisfactory hip function and no early postoperative complications. Use of a customized implant provides surgeons with an alternative option for patients where no suitable spacer or implant is available. However, the long-term function, longevity, and cost-effectiveness of the use of custom-made prostheses have yet to be fully explored.

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Impaction Bone Grafting or Uncemented Modular Stems for the Treatment of Type B3 Periprosthetic Femoral Fractures? A Complication Rate Analysis

Cited by 14 publications

References 33 publications

Femoral revision for periprosthetic fracture in total hip arthroplasty

Femoral revision for periprosthetic fracture in total hip arthroplasty

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

Total hip revision with custom-made spacer and prosthesis: A case report

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