Surgical Fixation of Vancouver Type B1 Periprosthetic Femur Fractures

Dehghan, Niloofar; McKee, Michael D.; Nauth, Aaron; Ristevski, Bill; Schemitsch, Emil H.

doi:10.1097/bot.0000000000000126

Cited by 59 publications

(42 citation statements)

References 33 publications

(43 reference statements)

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“…The literature also confirms the good results of the type B1 fracture treatment employing plate osteosynthesis. [8,13][Whereas in the case of type B2 and B3 fractures, a replacement operation with or without additional osteosynthesis is described as unavoidable. [10] Moazen's biomechanical analysis has compared the treatment with B1 and B2 fixations.…”

Section: Resultsmentioning

confidence: 99%

Results after surgical treatment of periprosthetic proximal femoral fractures Osteosynthesis with prosthesis preservation vs. prosthesis change

Zajonz

Pönick

Edel

et al. 2020

Preprint

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Background Periprosthetic fractures (PPF) of the femur close to the hip joint have serious consequences for most geriatric affected patients. In principle, apart from the highly uncommon conservative therapy, there are two therapeutic options. On the one hand, the prosthesis-preserving treatment by means of osteosynthesis using plates and/or cerclages in general is available. On the other hand, a (partial) change of the prosthesis with optionally additive osteosynthesis or a proximal femoral replacement can be performed because of prosthesis loosening or non-reconstructable comminuted fractures as well as most cemented stem variations. The aim of this retrospective study is the analysis of periprosthetic proximal femoral fractures in the presence of a total hip arthroplasty (THA). The outcome of the operated patients is to be investigated depending on the type of care (osteosynthesis with prosthesis preservation vs. prosthesis change). Material and methods: In a retrospective case analysis, 80 patients with THA and PPF were included. They were divided into two groups. Group I represents the osteosynthetic treatment to preserve the implanted HTEP (n = 42). Group II (n = 38) includes those patients who were treated by a change of their endoprosthesis with or without additional osteosynthesis. Specifics of all patients, like gender, age at fracture, interval between fracture and implantation, length of in-patient stay, body mass index, osteoporosis, corticomedullary index and complications such as infections, re-fracture, loosening, material failure or other complications, were recorded and compared. Furthermore, the patients were re-examined by a questionnaire and the score according to Merle d'Aubigné and Postel. Results: In group I the mean follow-up time was 48.5 ± 23 months (4 years) whereas group II amounted 32.5 ± 24.5 months (2.7 years) (p = 0.029). Besides, there were significant differences in age (81 ± 11 years vs. 76 ± 10 years, p = 0.047) and length of in-patient stay (14.5 ± 8.6 days vs. 18.0 ± 16.7 days, p = 0.014). According to the score of Merle d'Aubigné and Postel, there were significantly better values for the pain in group II with comparable values for mobility and walking ability. Conclusion: The treatment of periprosthetic proximal fractures of the femur is dependent on the classification (Vancouver and Johannsen) and in particular on the prosthetic anchoring as well as the extent of the comminution zone. Older patients and patients with osteoporosis are more frequently treated with an endoprosthesis revision. Patients, who have been treated with an osteosynthesis for preserving their endoprosthesis, showed a shorter length of in-patient stay and fewer complications than people with replacement surgery. In contrast to that, patients with prosthesis revision had better outcomes concerning the score of Merle d'Aubigné and Postel.

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Section: Resultsmentioning

confidence: 99%

Results after surgical treatment of periprosthetic proximal femoral fractures Osteosynthesis with prosthesis preservation vs. prosthesis change

Zajonz

Pönick

Edel

et al. 2020

Preprint

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“…A recent systematic review on 333 patients with Vancouver B1 periprosthetic femur fractures identified a total complication rate of 15%, with a revision surgery rate of 9%. Of interest, locking plates had higher rates of nonunion (9% vs 3%), and hardware failure (7% vs 2%) compared to cable plate/compression plate systems [ 34 ]. However, these findings need to be interpreted with caution due to lack of high-evidence studies and potential methodological flaws.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Concepts and Potential Future Developments for Treatment of Periprosthetic Proximal Femoral Fractures

Brand

Ettinger

Omar

et al. 2015

TOORTHJ

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Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies.

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“…Modi ed Vancouver classi cation and correspondent proposed treatment from Literature are shown in Tables 1 and 2, respectively. Anyway, there is no clear consensus on the optimal method of treatment for fractures around a stable femoral stem hip implant [22][23][24]. Type B1 fractures represent 30% and type C fractures represent 10% of all PFFs, and their treatment can be associated to a higher risk of complication than other PFFs types and high risk of failure due to nonunion with implant loosening and/or re-fracture [8,[25][26][27][28][29][30][31].…”

Section: Introductionmentioning

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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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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Surgical Fixation of Vancouver Type B1 Periprosthetic Femur Fractures

Cited by 59 publications

References 33 publications

Results after surgical treatment of periprosthetic proximal femoral fractures Osteosynthesis with prosthesis preservation vs. prosthesis change

Results after surgical treatment of periprosthetic proximal femoral fractures Osteosynthesis with prosthesis preservation vs. prosthesis change

Concepts and Potential Future Developments for Treatment of Periprosthetic Proximal Femoral Fractures

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.

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