chriswilson at cwilson
New User
Oct 13, 2007, 11:22 AM
Post #1 of 1
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FW: FW: [ORT-L] Fwd: [Ortho] Periprosthetic fx dislocation after THR
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This what a hip colleague of mine thinks
Chris Wilson
University Hospital
Cardiff
UK
Good case - Problems are :
1. Dislocation - as it was through Lat approach abductor
repair will also have failed
2. Fracture - In terms of classification doesn't fit
neatly into Vancouver Classification because both lesser &
greater trochanters are fractured - therefore is AL & AG.
Medial fracture line extends into diaphysis and would
therefore be more accurately defined as a B fracture. The
stem looks like a Zimmer proximally coated FMT therefore
as it is only 2 days post-op & given the morphology of the
fracture probably best described as a B2 fracture around
loose stem.
Treatment - Revision surgery to include -
1. Stem revision to stem which allowed distal fixation -
ie fully coated porous or tapered distal fixation stem.
2. Reduction of medial calcar fragment & greater
trochanter probably best achieved with trochanteric cable
plate system
3. Regarding instability - offset was obviously an issue
in primary surgery given long neck skirted head. Therefore
I would advise careful intra-operative assessment of
socket position and abductor damage. If component position
poor then revisie socket if not increase head size to 36mm
( which will also lateralise liner helping offset) or if
abductor damage significant consider constrained liner (
the Trilogy socket that is in place will allow for both
these options).
Cheers - Steve
On Sat, 13 Oct 2007 12:37:39 +0100
"Chris Wilson" <chriswilson@cwilson.net> wrote:
> What do you think?
>
> -----Original Message-----
>From: ORT-L-owner@www2.aaos.org
>[mailto:ORT-L-owner@www2.aaos.org] On Behalf
> Of Alexander Chelnokov
> Sent: 13 October 2007 05:21
> To: ORT-L@www2.aaos.org
> Subject: [ORT-L] Fwd: [Ortho] Periprosthetic fx
>dislocation after THR
>
> Dear colleagues
>
> The cae was presented to russian ortho list.
> Pls share your opinion.
>
> This is a forwarded message
>From: Michael Markushevich <orthoforum@weborto.net>
> To: ortho@weborto.net
> Date: Saturday, October 13, 2007, 1:23:42 AM
> Subject: [Ortho] Periprosthetic fx dislocation after THR
>
> ===8<==============Original message text===============
> Patient 77 years old man falled two day after elective
>THR operation.
> Was done noncemented THR, Direct Lateral Approuch .
>During prosedure
> wasn't any complication. Now we have Vancouver AL
>fracture (to be more
> precise between A to B1). What do you suggest?
>
> Michael Markushevich
>
> ===8<===========End of original message text===========
>
>
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
>
>
>
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