The inverted Vancouver C fracture. Case series of unstable proximal femur fractures above a knee revision stem treated by short cephalomedullary nail and lateral submuscular overlapping plate

Andrés-Peiró, José Vicente; Ruiz, María Jurado; Hernández, Jordi Tomás; Teixidor-Serra, Jordi; Marsá, Jordi Selga; Vázquez, Juan Antonio Porcel; Sánchez, Yaiza García; Garcia, Vicente Molero

doi:10.1007/s00590-020-02738-8

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…The complex scenario of an inter-prosthetic fracture has pushed some authors to use overlapping prophylactic plates. Peiró et al treated unstable proximal femur fractures above a knee revision stem with a combination of a short nail and an overlapping lateral plate and resulted in a 100% bone healing and well tolerated early weight bearing without records of major local complications ( 44 ). Campillo-Recio et al also concluded that, instead of treating such complex fractures, they preferred an effective, safe and reproducible preventive surgical approach, which would involve internal femoral splinting and a prophylactic plate ( 45 ).…”

Section: Discussionmentioning

confidence: 99%

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators’ recommendations

Castillón,

Muñoz Vives,

Aguado

et al. 2024

EFORT Open Reviews

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A peri-implant femoral fracture (PIFF) is defined as a femoral fracture in the presence of a pre-existing non-prosthetic implant. Classification systems, treatment guidelines and fixation strategies exist for peri-prosthetic fractures, but there is no standard of care regarding PIFFs. The aim of the Peri-Implant Spanish Consensus (aka PISCO) investigators is to reach an agreement regarding current practices for management of PIFFs and to propose four main principles to assess surgical treatment and prevention of these fractures. This consensus review was conducted according to the Delphi method. Twenty-two expert orthopaedic trauma surgeons performed the consensus and the definitive statements were approved unanimously. Biological fixation principles must be utilized in the surgical treatment of peri-implant femur fractures, which include closed or minimally invasive reduction techniques. The osteosynthesis must protect the entire bone. Gaps between two implants should be avoided. If implant overlap is not possible to achieve, then spanning inter-implant fixation systems must be used, especially in osteoporotic bone. Previous implants should be retained during surgical treatment of peri-implant femur fractures. Only those implants that would interfere with current fixation goals should be removed. If the previous implant is in the femoral neck region, then femoral neck protection must be maintained when treating the peri-implant fracture, even if the neck fracture has already healed.

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Section: Discussionmentioning

confidence: 99%

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators’ recommendations

Castillón,

Muñoz Vives,

Aguado

et al. 2024

EFORT Open Reviews

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“…This can be obtained using longer plates, with well-spaced screws, that span the whole femoral diaphysis, thereby increasing flexibility while avoiding stress risers that may jeopardize peri-implant fractures ( Figure 3B ); and a hybrid fixation technique with locking screws in the metaphyseal area and non-locking screws in the diaphysis [ 11 ]. Compared to the eight-cortex fixation approach around the stem that Ruchholtz et al described [ 6 ], we aimed for at least six cortices ( Figure 3C ), considering the results reported previously by Peiró et al with this implant while treating unstable proximal femur fractures above a knee revision stem [ 19 ]. In most of our patients, cerclage wiring was used as a reduction tool and not fixed to the plate.…”

Section: Discussionmentioning

confidence: 99%

Open reduction and polyaxial plating for stemmed knee periprosthetic fractures: A case series

Gonzalez-Morgado

Andrés-Peiró

Marsá

et al. 2023

SICOT-J

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Introduction: Stemmed total knee arthroplasty (STKA) periprosthetic fractures (PPFs) are an emerging problem affecting frail patients. Their surgical fixation is challenging, due to intramedullary involvement and poor bone stock. Polyaxial locking plating has yielded good results in implant-related femur fractures. We hypothesized that this treatment would provide similar results for STKA PPFs. Methods: Retrospective analysis of consecutive patients with a femoral PPF or inter-implant fracture around a knee revision stem who had undergone open reduction and periprosthetic-specific polyaxial plate fixation. Results: We found 14 cases of mean age 85.4 years. Cerclages were used in 80% of cases. Fixation of a mean 8.6 cortices around the revision stem was achieved, with an overall screw density of 1:2 or 1:3. Four patients lost their ability to walk, while four experienced postoperative local complications. Bone healing was achieved in all except one who died during hospitalization. The 13 remaining survived the first year of follow-up. Conclusion: STKA PPFs are an emerging and challenging problem affecting frail patients. Treatment using polyaxial locking plates provides stable fixation allowing early mobilization despite high complication rates.

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The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review

Schopper

Luger

Hipmair

et al. 2022

BMC Musculoskelet Disord

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Background Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification. Methods Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews. Results One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899). Conclusions Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use.

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The inverted Vancouver C fracture. Case series of unstable proximal femur fractures above a knee revision stem treated by short cephalomedullary nail and lateral submuscular overlapping plate

Cited by 3 publications

References 25 publications

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators’ recommendations

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators’ recommendations

Open reduction and polyaxial plating for stemmed knee periprosthetic fractures: A case series

The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review

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