Periprosthetic femoral nonunions treated with internal fixation and bone grafting

Prins, Jonne; Donders, Johanna C. E.; Helfet, David L.; Wellman, David S.; Klinger, Craig E.; Redko, Mariya; Kloen, Peter

doi:10.1016/j.injury.2018.10.019

Cited by 11 publications

(14 citation statements)

References 31 publications

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“…In these cases, a second mechanical support appears useful. A structural allograft is recommended medially while anteriorly both a structural allograft or a second plate can be used [28,56,[72][73][74], sounding better a medial than an anterior reinforcement [64]. A structural allograft is in our opinion better than a second plate as it can bring osteoconductive support as well, especially if a pharmacological anabolic treatment is performed.…”

Section: Discussionmentioning

confidence: 89%

“…Anyway, we focused on a particular group of patients presenting re-fracture / nonunion of a PFF that were treated with repeated osteosynthesis and stem retention: revision arthroplasty for failed osteosyntheses can guarantee good results [54,55] and re-osteosynthesis can be applied to few cases, even if in continuous increase. Also, we based our proposal of a therapeutic algorithm to reduce failures in PFFs' treatment not only on the analyses of our series but also on the review of Literature [25,28,34,42,56]. Fractures with a stable stem (Vancouver B1 and C) are commonly treated by ORIF or by MIPO; ORIF can be enhanced with a structural allograft or with a second plate.…”

Section: Discussionmentioning

confidence: 99%

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Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Mondanelli

Colasanti

Cataldi

et al. 2020

Preprint

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Background: There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Based on our experience in the treatment of nonunions after PFFs and other challenging cases and on Literature, we propose an algorithm that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem.Methods: We retrospectively reviewed data on patients who failed to heal after a surgically treated Vancouver type B1 or C PFF. All patients were treated with locking plate, double structural allograft and autologous bone marrow concentrate (BMC) over a platelet-rich plasma (PRP)-based membrane at fracture site. All patients were also pharmacologically treated with Teriparatide in the postoperative period. We studied patients with radiograms, histological evaluation of the nonunion area, and phosphocalcic metabolism. Patients were assessed subjectively, clinically and radiographically until healing and then annually.Results: All nonunions healed over a six months period, and functional recovery appeared to be good. Retrospective evaluation of the proposed algorithm showed that none of the patients met biological or mechanical criteria such as to make valid the treatment with locking plate alone.Conclusion: Mechanical factors are not the only issues that should be taken into account when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions are factors that should drive to a rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous BMC in a PRP-based scaffold) and systemic anabolic treatment (Teriparatide) in the first instance. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, taking into account mechanical and biological criteria.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Mondanelli

Colasanti

Cataldi

et al. 2020

Preprint

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“…However, we based our proposal of such a therapeutic algorithm to reduce failures in PFFs’ treatment not only on the analyses of our series but also on the review of Literature. 25 , 28 , 34 , 46 , 77 …”

Section: Discussionmentioning

confidence: 99%

Combined Surgical and Medical Treatment for Vancouver B1 and C Periprosthetic Femoral Fractures: A Proposal of a Therapeutic Algorithm While Retaining the Original Stable Stem

Mondanelli

Troiano

Facchini

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Evidence exists that some patterns of fracture around a stable stem are better treated with revision surgery than with standard fixation. Anyway, a more aggressive surgical procedure together with medical treatment could allow for stem retention, and reduced risk of nonunion/hardware failure, even in these cases. Significance This paper is placed in a broader context of lack of studies on the matter, and its aim is to shed some light on the management of PFFs around a stable stem, when peculiar mechanical and biological aspects are present. Results Based on our casuistry in the treatment of nonunions after PFF successfully treated with original stem retention, and on review of Literature about risk factors for fixation failure, an algorithm is proposed that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem, without resorting to revision. Mechanical (major and minor) and biological (local and systemic) factors that may influence fracture healing, leading to nonunion and hardware failure, and subsequent need for re-operation, are considered. The proposed surgical technique consists of rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous bone marrow concentrate over a platelet-rich plasma-based scaffold) at fracture site. Systemic anabolic treatment (Teriparatide) is also administered in the post-operative period. Conclusion Mechanical factors are not the only issues to be considered when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions should be taken into account, as well. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, considering mechanical and biological criteria.

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“…Fracture non-union is reported in 3 to 9% of people with periprosthetic femoral fractures and 73% are successfully managed with a single revision procedure using orthogonal bone plating, cancellous bone graft placement and stem retention. 36 Radiographs should be carefully evaluated for evidence of stem instability before explantation and stem revision or amputation considered in these challenging cases.…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

Monotti

Preston²,

Kidd³

2020

Vet Comp Orthop Traumatol

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Objective The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant. Methods Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians. Results Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases. Conclusions While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.

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Periprosthetic femoral nonunions treated with internal fixation and bone grafting

Cited by 11 publications

References 31 publications

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Combined Surgical and Medical Treatment for Vancouver B1 and C Periprosthetic Femoral Fractures: A Proposal of a Therapeutic Algorithm While Retaining the Original Stable Stem

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

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