OWL: OCOSH Classification/Trauma/Fractures/Femur Fractures/Periprosthetic Fractures

Dall Miles Cable And Plate Fixation System In The Treatment Of Periprosthetic Femoral Fractures

Sandhu et al — 2006-04-19 10:53:53 GMT

Dall-Miles cable and plate fixation system in the treatment of periprosthetic femoral fractures: a review of 20 cases R Sandhu, K Avramidis, C Johnson-Nurse Department of Trauma and Orthopaedics, James Paget Hospital, Great Yarmouth, Norfolk, UK PURPOSE. To assess the effectiveness of Dall-Miles cables and plates in the treatment of periprosthetic femoral fractures around hip arthroplasties. METHODS. We retrospectively reviewed 20 cases of periprosthetic femoral fracture treated with the Dall-Miles cable and plate system between November 1999 and December 2002 in James Paget Hospital in the United Kingdom. Demographic data, fracture type, and surgical outcome of the patients were reviewed and assessed. RESULTS. Of the 20 cases of periprosthetic femoral fracture, one was of Vancouver type A, 15 were of type B1, and 4 were of type C. The mean age at operation was 78.5 years (range, 68-90 years) with a male to female ratio of 11:9. The mean time to union was 3.9 months (range, 3-8 months), and the mean follow-up period was 19.4 months (range, 1-4 years). 15 patients achieved satisfactory results, including 2 delayed unions that healed with a residual varus deformity of 15 degrees in the femoral component. Three patients developed deep-seated wound infections. No nonunion of fractures or fixation system failures occurred. CONCLUSION. The Dall-Miles cable and plate fixation system alone is a sufficient treatment for most periprosthetic femoral fractures. In the management of B1 fractures, there was no significant difference in clinical outcome, despite the various combinations of cables and screws used for stabilisation of the plate. However, in cases of comminution at the fracture site, junctional grafting with morsellised autograft may be used in addition to internal fixation to accelerate union. Journal of Orthopaedic Surgery 2005;13(3):259-66

Discussion of a periprosthetic femor shaft nonunion

Alex Chelnokov — 2007-10-03 10:53:53 GMT

Case discussion of a well illustrated case

Femur Fracture Following Tkr

CRWheeless — 2006-04-19 10:53:53 GMT

Wheeless Textbook of Orthopaedics Discussion: - known risk factors include notching of the femur, osteoporosis, and excessive polyethylene wear (w/ subsequent osteolytic defect) - Radiographs: - often oblique radiographs are needs as well as AP and Lateral views, due to the rotation of the distal fragment; - lateral radiographs will demonstrate whether the TKR is PCL retaining or sacrificing (the later is more difficult to fix since the intercondylar notch is covered by metal); - Non Operative Treatment: - generally non operative treatment is avoided, except in patients with excessive co-morbidity; - approximately 35% will experience a complication that will require component revision; - 20% non union rate and 23% rate of malunion; - permanent knee stiffness is common; - in the study by Culp et al 1987, one half of patients treated non operatively had increased pain and/or signficant decreased function vs. 13.3% in the control group; - Retrograde Nailing: - advantages include ability to exchange the liner (if necessary) and to insert the nail retrograde thru the intercondylar notch - both thru an anterior approach; - disadvantages - in the case of a closed box posterior stabilized design retrograde nailing will not be possible; - even w/ an open box design, the space available for nail passage is limited (usually less than 14 mm), which often means that under-sized nail will have to be used; - include less than rigid fixation - possibility of stress risers which may lead to mid shaft femoral frx (as has been reported w/ Seligson nails);

Femur Supracondylar Periprosthetic fracture

Chelnokov — 2007-10-04 10:53:53 GMT

A male 41 years old transferred to our unit with 3 week old femoral fracture near the knee prosthesis after a mimimal fall. In 1994 he sustained multiple injury with open patella fracture (complicated with septic arthritis), and ipsilateral femoral shaft fracture treated by ex-fix.
TKA performed in 1998. In 2001 he got a periprosthetic fracture which was treated nonoperatively and healed with ~1 cm dorsal displacement of the distal femoral block. Knee ROM prior the recent injury was about 90-95 degrees. He didn't use walking aid.
Case Discussion and operative solution posted

Four Recurrent Periprosthetic Knee Fractures

Koop et al — 2006-04-19 10:53:53 GMT

Case Report Four Recurrent Periprosthetic Knee Fractures from Medscape Orthopaedics & Sports Medicine eJournal[TM] 2001 Arne-Lembit K��p, MD, Andres K��p, MD, Irja Kiisk�la, MD Introduction Periprosthetic fractures of the knee are challenging for the orthopaedist, but recurrent periprosthetic fractures are even more challenging. In this case, a 61-year-old female patient with a diagnosis of gonarthrosis deformans suffered 4 ipsilateral periprosthetic fractures during the 4.5-year period following her primary total-knee arthroplasty. A detailed case report is presented here and the classification systems, risk factors, and treatment strategies for periprosthetic fractures are discussed.

Healing rate 90% when using structural allografts for periprosthetic fractures Ortho SuperSite

Rapp — 2007-10-04 10:53:53 GMT

Plating, nailing, stemmed TKR components are options for managing supracondylar fractures. By Susan M. Rapp ORTHOPEDICS TODAY 2007; 27:26 June 2007 Fractures that occur around total knee replacement prostheses can be prevented. But when faced with such a fracture, Allan E. Gross, MD, FRCS, has relied on some key factors to help him select the most appropriate treatment for his patients. At a recent Current Concepts in Joint Replacement meeting he presented options for preventing and treating a variety of supracondylar fractures.

Infection, periprosthetic fractures the major factors for TKA reoperation

Gina Brockenbrough — 2007-10-03 10:53:53 GMT

Decreased long-term implant survivorship linked with age at surgery, failed high tibial osteotomy. By Gina Brockenbrough 1st on the web (May 15, 2006) May 2006 CHICAGO � As designs for cemented total knee implants have improved, infection and periprosthetic fractures have emerged as the greatest threats for component replacement, revision and reoperation.

Intra-operative Fractures During Primary Total Hip Arthroplasty

Mabry et al — 2007-10-07 10:53:53 GMT

a report by Tad M Mabry,MD, Miguel E Cabanela,MD and Arlen D Hanssen,MD
Department of Orthopaedic Surgery, Mayo Clinic College of Medicine Intra-operative periprosthetic fractures complicating primary total hip arthroplasty (THA) can occur around the acetabulum or the femur. These fractures exhibit considerable variation in severity, and their appropriate identification and management directly affects patient outcomes.

Management of Fractures Around Total Knee Replacement

Wiedel — 2008-03-11 10:53:53 GMT

by Jerome D. Wiedel, M.D. In: Total Knee Arthroplasty: A Comprehensive Approach Editors: Hungerford, David S., Krackow, Kenneth A. and Kenna, Robert V. Fractures about replacement components are becoming more widely recognized as a complication following total knee arthroplasty. The incidence seems to be increasing as the number of patients and the length of follow-up increase.

Our Experiences With The Treatment Of Periprosthetic Fractures Of The Femur

Pleva et al — 2006-04-19 10:53:53 GMT

Our Experiences with the treatment of periprosthetic Fractures of the Femur Biomed Papers 148(1) 75-79 2004 Leopold Pleva, Milan Sir, Roman Madeja Centre of Traumatology, University Hospital, Ostrava, Czech Republic

Periprosthetic Fracture Of The Femur After Hip Arthroplasty

Wang & Wang — 2006-04-19 10:53:53 GMT

Periprosthetic Fracture of the femur after hip arthroplasty: the clinical outcome after cortical strut allograft. Review of 15 patients treated with strut allografts.

Periprosthetic Fractures

Rabin — 2006-04-19 10:53:53 GMT

Periprosthetic Fractures Last Updated: March 18, 2005 Author: Steven I Rabin, MD, Associate Professor of Orthopedic Surgery and Rehabilitation, Loyola University of Chicago; Chief, Section of Orthopedic Trauma, Department of Orthopedic Surgery, Loyola University Medical Center Sections Introduction Indications Relevant Anatomy And Contraindications Workup Treatment Complications Outcome And Prognosis Future And Controversies Pictures Bibliography Fractures around implants pose unique fixation challenges. The original placement of the implant may predispose to later fracture, the long-term presence of the device may change the structure of the bone and increase susceptibility to fracture, and the implant itself may interfere with healing or the placement of other fixation devices. The number of implants in the femur is increasing as the population ages, and the indications for joint replacement and fixation increase. Fractures around joint replacement prostheses are commonly called periprosthetic fractures, while fractures around plates, rods, or prostheses can be more generally termed peri-implant fractures. As more peri-implant fractures occur, the orthopedic surgeon needs to learn methods to manage the specific problems involved.

Periprosthetic Fractures in Total Hip Arthroplasty

Van Flandern — 2007-10-03 10:53:53 GMT

Periprosthetic Fractures in Total Hip Arthroplasty By Geoffrey J. Van Flandern, MD September 2005 Abstract Periprosthetic fractures can be discussed in many formats. In this article, epidemiology, classification, and treatment are divided into the following three categories of periprosthetic fracture: intraoperative fractures detected at the time of surgery; intraoperative fractures undetected at the time of surgery, but detected postoperatively; and postoperative fractures occurring late after the arthroplasty procedure.

Periprosthetic Fractures Of The Femur

Schmidt — 2006-04-19 10:53:53 GMT

Periprosthetic Fractures of the Femur CME Author: Andrew H. Schmidt, MD Release Date: December 21, 2000; Valid for credit through December 21, 2001 Introduction Epidemiology Anatomy Classification Fractures of the Femur After Hip Replacement Fractures of the Femur After Knee Replacement Treatment Nonoperative Treatment Operative Treatment Special Considerations: Fractures Around Femoral Stems Prevention References

Periprosthetic Supracondylar Fracture of the Femur MyPacs

Maclennan — 2007-10-04 10:53:53 GMT

Radiology Teaching Files > Case 3650050 never visited PERIPROSTHETIC SUPRACONDYLAR FRACTURE OF FEMUR ON 63 Y/O XR KNEE Contributed by: alex maclennan, Radiologist, Royal Alexandra Hospital, Paisley, United Kingdom.