Treatment Algorithm of Periprosthetic Femoral Fracturens

Abstract

Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients’ functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients’ early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the “real” level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.

Detection of periprosthetic fractures around the femoral stem by resonance frequency analysis: An in vitro study

“…Although the frequency shift tends to increase as a function of the crack length, the data are quiet scattered because the fracture path, depth, and thickness depend on the sample, which could not be measured in this study. It is worth noting that the periprosthetic fractures studied herein are among the less severe according to the Vancouver classification, 17 with small consequences on the FS stability, 18 which indicates the good sensitivity of the frequency method investigated in the present paper.…”

“…However, the inter-specimen variability σ spec does not affect the detection of the fracture by the method proposed herein, since the protocol consists in comparing at least two FRFs for a same specimen, one of which being for the non-fractured state. The decrease of pre-stressed state of the bone-implant system due to the fracture 19,37 leads to a decrease of the system rigidity, 4,17,18 which is responsible for a substantial change of the system vibro-acoustic response. In particular, the shift of the FRF to lower frequencies is consistent with a loss of rigidity of the system 24,26,38 due to the periprosthetic bone fracture.…”

“…The fractures of type B are then subdivided depending on the stability of the implant: the type B1 correspond to a stable implant whereas the types B2 and B3 are associated with a loss of implant stability, depending on the seriousness of implant loosening. 16,17…”

Functional Outcomes of Anterior-Based Muscle Sparing Approach Compared to Direct Lateral Approach for Total HIP Arthroplasty Following Acute Femoral Neck Fractures

“…Three patients in the ABMS group underwent subsequent re-operations: 1 patient was successfully treated with a dèbridement, antibiotics and implant retention (DAIR) procedure for early PJI; 2 patients had an open reduction and internal fixation (ORIF) for a Vancouver B1 periprosthetic femoral fracture. 25 4 patients in DL group had a subsequent surgery: 1 dislocation was treated with open reduction and liner exchange with a double mobility option, 1 early PJI was treated with a DAIR procedure while a late PJI was treated with a 2-stage revision, and 1 Vancouver B1 periprosthetic femoral fracture was treated with ORIF.…”

The difficulty of choosing the method of analgesia after total replacement of the lower limb large joints (case report, literature review)

“…02.06.2021 состоялся повторный внутриклинический разбор. Перипротезный перелом у пациентки отнесён к типу B3 -перелом с плохим качеством кости и нестабильной ножкой -по модифицированной Ванкуверской классификации послеоперационных перипротезных переломов [1].…”