Enes.Kanlic at ttuhsc
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Dec 16, 2008, 12:45 PM
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RE: [ORT-L] Periprosthetic fracture ... options (Revision)...
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Alex,
Although, there is just one view, it seems that cement is still holding
well on lateral side, cup also seems to be stable, but inside is
asymmetric - poly is damaged ... options:
1. "Easy": long lateral plate and anterior strut allograft w/wo bone
grafting
2. "Harder" Removal of prosthesis (has to be done if it is loose in
remnant of intact proof proximal femur), and new long stem, porous
coated prosthesis with new cup (pt is 59years old, probable in good
health - survived 6 weeks of traction... this would be my 1st option)
3. I can not imagine how any "custom" nail might work, introduced from
the knee, as you have been suggesting :O !!??
Sincerely,
Enes M. Kanlic, MD, FACS
Professor
http://www.ttuhsc.edu/elpaso/som/Orthopaedics/
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-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
Behalf Of Alexander Chelnokov
Sent: Tuesday, December 16, 2008 1:21 PM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] Periprosthetic fracture
Dear All.
A male 59 y.o. referred to our unit >6 weeks after car accident.
Initially managed on
traction. Cemented THR 5 years ago (DePuy Elite +).
How would you estimate the fracture - the stem looks stable, i.e.
Vancouver B1. Or B2?
Now the femur is deformed to varus and shortened, manual traction
already not enough to restore length/axis.
How would you manage the patient?
I think about custom-made retrograde nail which connects to the stem.
Never performed it to a cemented stem. Some site opening may be
necessary to remove at least pieces of broken cement mantle. Also
application of an ex-fix for longitudinal traction looks useful.
THX for your opinion.
--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
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