[ORT-L] Periprosthetic fracture of the femur


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[ORT-L] Periprosthetic fracture of the femur

alex at weborto
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Aug 17, 2007, 9:11 PM

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[ORT-L] Periprosthetic fracture of the femur	Can't Post

Dear All,

A female 74 y.o. fell at day 7th after cemented THA. The
femur is split from the tip of the troch (preexisted crack?) and goes
below the tip of the stem. Images attached. What type the fracture is
according to Vancouver classification?
We consider some kind of plating. What type of implant would you prefer?
How long the plate should be? Is cable technique necessary? Grafting?
Any probable pitfalls to concern? THX!

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

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bray at renoortho
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Aug 17, 2007, 10:38 PM

Post #2 of 3 (2600 views)
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RE: [ORT-L] Periprosthetic fracture of the femur [In reply to]	Can't Post

In our aging population we are, unfortunately, seeing more of these; Use the
fracture table supine, traditional lateral approach; we like the Stryker
cable plate, most any modern design will do; first reduce the fracture with
reduction clamps then cable the reduction with the metal clamps anterior so
they don't interfere with the lateral plate application. Remove the clamps,
check the reduction and then apply a 12-14 hole plate from the tip of the
trochanter to below the tip of the prosthesis to allow 6- 8 cortices of
distal screw fixation. Cemented stems are actually better for fixation as
you may be able to angle proximal screws through the cement mantel for
increased proximal fixation stability. Two additional cables around the
bone/plate construct in addition to the two reduction cables with the
proximal screws should be adequate fixation. There is data now to suggest
allograph struts are not as frequently indicated, possibly due to better
fixation options. We have used BMP sponges (Infuse) applied medially along
the fracture site prior to closing the wound without a drain. Non weight
bearing for 10- 12 weeks, DVT prophylaxis 21 days, good diet, no smoking.
Good Luck, Tim Bray, Pete Althausen, Tim O'Mara- Reno Ortho Clinic Fracture
Service

-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On Behalf
Of Alexander Chelnokov
Sent: Friday, August 17, 2007 9:12 PM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] Periprosthetic fracture of the femur

Dear All,

A female 74 y.o. fell at day 7th after cemented THA. The
femur is split from the tip of the troch (preexisted crack?) and goes
below the tip of the stem. Images attached. What type the fracture is
according to Vancouver classification?
We consider some kind of plating. What type of implant would you prefer?
How long the plate should be? Is cable technique necessary? Grafting?
Any probable pitfalls to concern? THX!

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

---
[This E-mail scanned for viruses by Declude Virus]

doktorfb2001 at yahoo
New User

Aug 18, 2007, 1:19 AM

Post #3 of 3 (2600 views)
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Re: [ORT-L] Periprosthetic fracture of the femur [In reply to]	Can't Post

I think this fracture is Vancouver type B2(prosthesis unstable). I prefer you to remove the femoral stem with a cementless long stem revision prosthesis, trochanteric grip, cerclage, distal femoral LISS plate(from the femoral condyle to the tip of the stem). No need to the cortical strut greft because there is no rotational instability(oblique fracture). If there will be cortical bone defect, you can use BMP and corticospongios greft. If I helped you, I will be happy.
Op.Dr. Fuat B�LG�L� Taksim Training Hospital Orthopedic and Traumatology Istanbul/TURKEY

Alexander Chelnokov <alex@weborto.net> wrote:
Dear All,

A female 74 y.o. fell at day 7th after cemented THA. The
femur is split from the tip of the troch (preexisted crack?) and goes
below the tip of the stem. Images attached. What type the fracture is
according to Vancouver classification?
We consider some kind of plating. What type of implant would you prefer?
How long the plate should be? Is cable technique necessary? Grafting?
Any probable pitfalls to concern? THX!

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

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