Management Of Periprosthetic Fractures Research Articles

The Nonoperative Management of Periprosthetic Fractures Associated With the Birmingham Hip Resurfacing Procedure

We reviewed the outcome of 7 patients sustaining undisplaced femoral neck periprosthetic fractures associated with the Birmingham hip resurfacing procedure. All fractures presented within 4 months of initial surgery. All fractures were treated conservatively with a period of nonweight bearing. The 7 patients were assessed clinically and radiologically at a minimum of 16 months postfracture. All fractures had fully united. There was no evidence of impaired function or abnormal radiological findings after this conservative treatment strategy in 6 patients. One patient had marked femoral neck narrowing but no functional impairment.

Periprosthetic fractures associated with osteolysis: A problem on the rise

Periprosthetic fractures caused by osteolysis can occur in the pelvis, peritrochanteric area, or femoral diaphysis after hip arthroplasty. Most, but not all, hips are ultimately treated surgically to manage the osteolysis or to stabilize the fracture. Some stable, minimally displaced fractures of the pelvis and greater trochanter can be allowed to heal before revision is considered, which simplifies the operation. Unstable fractures, especially of the femoral diaphysis, are usually treated with early repeat surgery following the established principles of periprosthetic fracture management. © 2003 Elsevier Inc. All rights reserved.

Preliminary experience of the Cannulok revision hip prosthesis in late periprosthetic fracture management.

We report our preliminary experience of a cannulated, distally locked revision femoral component to manage peri-prosthetic fractures in the elderly. The majority of cases in our series were further complicated by osteolysis secondary to aseptic loosening, the original hip arthroplasties having been in situ for several years. Sixteen patients with an average age of 77 underwent treatment of periprosthetic fractures with the Cannulok Hip. The device combines techniques of revision hip surgery with locked intramedullary nailing. We describe our initial evaluation of this modular prosthesis which has enabled us to satisfactorily treat periprosthetic fractures with early mobilisation and discharge from hospital. In all of our surviving patients the fractures have united within four to six months. All cases were in addition treated with proximal femoral impaction allografting leading to improved local bone stock. We believe this implant may provide a satisfactory alternative for the management of periprosthetic fracture in the presence of a loose femoral component. (Hip International 2002; 1: 1-10).

Dall-Miles plating for periprosthetic B1 fractures of the femur

Eight patients (9 fractures) who have been treated with Dall-Miles plating in this unit between April 1996 and October 1997 for ipsilateral periprosthetic fractures around total hip replacement (7 cases) and total knee replacement (2 cases) have been reviewed. Four were men, and 4 were women. The average age at the time of operation was 77 years (range, 65–89 years). The average follow-up period was 14.6 months (range, 6–24 months). Three fractures healed satisfactorily with no evidence of malunion (3 of 9). The final results was unsatisfactory in the other 6 fractures. The femoral component had been inserted in a varus position in all the failures but was in a neutral position in the 3 successes. Procedures other than Dall-Miles plating might be more appropriate in the management of periprosthetic fractures in which the femoral component is in a varus position.