Fixation Of Periprosthetic Fractures Research Articles

Fixation techniques for periprosthetic femur fractures around total knee arthroplasty: a systematic review

There is no consensus regarding the treatment algorithm for the fixation of periprosthetic femur fractures (PFFs) around a total knee arthroplasty (TKA). Established methods of fracture fixation include locking plate (LP) or retrograde intramedullary nail (RIN) techniques. Newer fixation methods include the dual plate (DP) and the nail-plate combination (NPC) techniques. The purpose of this study is to review the literature on the outcomes of PFF fixation following TKAs over the past two decades. A systematic review was undertaken in the MEDLINE, Embase, and Cochrane databases in accordance with the PRISMA standards. Selection criteria included: patient cohort > 5 cases and minimum follow-up of 12 mo. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklists for Cohort Studies and Case Series. Combined data analysis was performed with linear models and linear mixed effect models to compare the post-operative outcomes of the LP, RIN, and DP techniques. Our search identified 1086 studies and 31 were selected for final analysis. The number of the studies for the LP, RIN, DP, and NPC techniques were 23, 15, 4, and 1, respectively. There were no differences in the time to union, Knee Society Knee Score, or range of motion among the LP, RIN, and DP techniques. Although analysis did not demonstrate significant differences, it is limited by the lack of the available studies using the DP technique. Additionally, only one study for the NPC technique was retained after screening and data analysis was therefore not possible.

Fixation or Revision for Periprosthetic Fractures: Epidemiology, New Trends, and Projections in the United States.

Periprosthetic fractures can be devastating complications after total joint arthroplasty (TJA). The management of periprosthetic fractures is complex, spanning expertise in arthroplasty and trauma. The purpose of this study was to examine and project trends in the operative treatment of periprosthetic fractures in the United States. A large, public and private payer database was queried to capture all International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for periprosthetic femoral and tibial fractures. Statistical models were created to assess trends in treatment for periprosthetic fractures and to predict future surgical rates. An alpha value of 0.05 was used to assess significance. A Bonferroni correction was applied where applicable to account for multiple comparisons. In this study, from 2016 to 2021, 121,298 patients underwent surgical treatment for periprosthetic fractures. There was a significant increase in the total number of periprosthetic fractures. The incidence of periprosthetic hip fractures rose by 38% and that for periprosthetic knee fractures rose by 73%. The number of periprosthetic fractures is predicted to rise 212% from 2016 to 2032. There was a relative increase in open reduction and internal fixation (ORIF) compared with revision arthroplasty for both periprosthetic hip fractures and periprosthetic knee fractures. Periprosthetic fractures are anticipated to impose a substantial health-care burden in the coming decades. Periprosthetic knee fractures are predominantly treated with ORIF rather than revision total knee arthroplasty (TKA), whereas periprosthetic hip fractures are predominantly treated with revision total hip arthroplasty (THA) rather than ORIF. Both periprosthetic knee fractures and periprosthetic hip fractures demonstrated increasing trends in this study. The proportion of periprosthetic hip fractures treated with ORIF relative to revision THA has been increasing. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures.

The retrograde femoral nailing advanced (RFNA) system (DePuy synthes) is a commonly used implant for the fixation of low distal femur and periprosthetic fractures. There is concern that the rate of distal interlock screw back-out may be higher for the RFNA compared to other nails (ON). The purpose of this study was to evaluate the incidence of interlock screw back-out and associated screw removal for RFNA versus ON, along with associated risk factors. A retrospective comparative study of patients who underwent retrograde nailing for a distal femur fracture at an academic level one trauma center was performed. The incidence of distal interlock screw back-out and need for screw removal were compared for RFNA versus a propensity score matched cohort who received other nails. One hundred and ten patients underwent retrograde nailing with the RFNA for a distal femur fracture from 2015 to 2022 (average age: 66, BMI: 32, 52.7% smokers, 54.5% female, 61.8%). There was a significantly higher rate of interlock back-out in the RFNA group compared to the ON (27 patients, 24.5% vs 12 patients, 10.9%, p = 0.01), which occurred 6.3weeks postoperatively. Screw removal rates for back-out were not significantly different for the RFNA group versus ON (8 patients, 7.3% vs 3 patients, 2.7%, p = 0.12). In this retrospective comparative study of distal femur fractures treated with retrograde nailing, the RFNA implant was associated with an increased risk of distal interlock screw back-out compared to other nails.

Comparing the Biomechanical Stability of Cerclage Cable with Plate Insert Versus Locking Screw in Periprosthetic Humeral Fracture.

In the setting of periprosthetic humeral fractures, the humeral stem of the implant represents a substantial challenge to the optimal method of proximal fixation. This study aimed to compare the initial biomechanical stability provided by cerclage cables with a locking plate insert versus bicortical locking screws (i.e., the gold standard for fixation) in fresh cadaveric humeri. After calculating the sample size, we utilized 10 sets of cadaveric specimens and created a 5-mm osteotomy gap 120 mm distal to the tip of the greater tuberosity, simulating a Wright and Cofield type-B periprosthetic humeral fracture on each specimen. Using 3 locking screws for distal fragment fixation, identical in all specimens, the specimens were assigned to Group A (3 cerclage cables with a plate insert) or Group B (3 locking bicortical screws) for proximal fragment fixation. Biomechanical tests included stiffness in varus and valgus bending, torsion, and axial compression, and a single load to failure. No significant differences were observed in the biomechanical metrics between the 2 groups. Our study revealed that fixation with use of cerclage cables with a plate insert demonstrated biomechanical stability comparable with that of bicortical locking screw fixation when addressing the proximal fragment in Wright and Cofield type-B periprosthetic humeral fractures. For proximal fragment fixation of periprosthetic humeral fractures, cerclage cables with a plate insert can be utilized as an effective fixation method that offers initial fixation strength that is comparable to the use of 3 locking bicortical screws.

Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis.

Periprosthetic femoral fracture (PFF) is a common complication after total hip arthroplasty, and open reduction and internal fixation (ORIF) is a common surgical treatment. We conducted a meta-analysis to compare the outcomes of ORIF in patients with different fracture patterns (Vancouver B1 and B2). We conducted a systematic search of PubMed, Embase, Cochrane Library and KoreaMed from inception to August 2022. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the 10 comparative studies and a proportional meta-analysis on the data from the 39 articles to determine a consensus. The outcomes were the incidence of reoperations that included osteosynthesis, irrigation/debridement and revision arthroplasty. The pair-wise meta-analysis showed similar outcomes between two groups; the risk of reoperation (odds ratio [OR]=0.82, confidence interval [CI] 0.43-1.55, P=0.542), nonunion (OR=0.49; CI 0.22-1.10, P=0.085) and deep infection (OR=1.89, CI 0.48-7.46, P=0.361). In proportion meta-analysis, pooled prevalence of reoperation was 9% (95% CI, 6-12) in B1 and 8% (95% CI, 2-15) in B2 (heterogeneity between two groups (Q), P=0.772). The pooled prevalence of nonunion was same as of 4% in B1 and B2 (Q, P=0.678), and deep infection was 2% (95% CI, 1-3) in B1 and 4% (95% CI, 2-7) in B2 (Q, P=0.130). ORIF is a feasible treatment for B1 and B2 periprosthetic femoral fractures, with acceptable outcomes in terms of, nonunion and infection. The results of this study would help clinicians and provide baseline data for further studies validating PFF.

Lower Rates of Femoral Fracture and Subsidence with a Morphometric Stem in Cementless Total Hip Arthroplasty.

A "morphometric" tapered femoral stem with size-specific medial curvatures and proportional neck lengths was introduced, attempting to improve fixation and biomechanics in cementless total hip arthroplasty (THA) across a range of femoral sizes and morphotypes. We investigated whether this design reduced complications and better restored anatomy (e.g., limb length and offset) compared to a traditional tapered stem with consistent neck lengths across sizes. We reviewed 389 THAs (340 patients) performed using either of two cementless femoral implants. Records were reviewed for demographics, surgical details, complications, and reoperations. Radiographs were examined for subsidence, biologic fixation, leg lengths, offset, and proximal femoral morphology. The intraoperative fracture rate was lower with this morphometric stem compared to this traditional stem (0 vs. 3.4%), as was the incidence of postoperative subsidence ≥3mm (4.7 vs. 19.2%). With the numbers available, no differences were identified regarding rates of reoperation for periprosthetic femur fracture (0 vs. 1.0%) and femoral fixation failure without fracture (1.1 vs. 0%), or all-cause reoperations (2.7 vs. 2.4%). Limb length and offset restoration were similar with the two implants, but the shortest available femoral head was used less frequently with this morphometric stem compared to this traditional stem (22 vs. 54%). This morphometric stem was associated with decreased rates of intraoperative fracture and postoperative subsidence, along with decreased use of the shortest available head. Nevertheless, both implants demonstrated clinical success, allowing reconstruction of limb length and offset with low rates of femoral fixation failure.

Adequate bone healing after supplementary fixation of periprosthetic total knee arthroplasty fractures using Luque cerclage wiring: a retrospective case series.

Cerclage wiring is a well-known supplemental fixation technique that can be used in many types of fractures. With the tendency toward minimally invasive approaches in the management of periprosthetic total knee arthroplasty (TKA) fractures, and with absence of a dedicated study that reports the results of cerclage wiring in TKA fractures in particular, the aim of this retrospective study is to report the outcomes of supplementary cerclage wiring using simple Luque wires in fractures of distal femur associated with TKA. Eighteen cases, with a mean age of 77.2years had complete follow-up data and had their radiographs and clinical data assessed for this study. Patients received cerclage wiring along with plates, retrograde nailing or around cracked femoral shaft overlying revision TKA femoral stem during the surgical management of periprosthetic TKA distal femur fractures. Fracture healing with adequate callus formation occurred in all 18 cases at a mean of 11.4weeks postoperatively. None of the cases had any vascular injury, and after a mean clinical follow-up of 51weeks, none of the cases had nonunion or hardware complications. One case had postoperative periprosthetic infection that developed 8months after full fracture healing and had a two-stage revision using revision stemmed TKA and protective cerclage wiring with successful eradication of infection. Supplementary cerclage wiring in distal femur TKA fractures can aid in enhanced bone healing with minimal complications, provided that adequate reduction and rigid fixation were achieved. This study reflects the level of evidence IV.

EXAMINING THE COMPLICATION AND REOPERATION RATES AFTER OSSEOINTEGRATED RECONSTRUCTION

IntroductionOsseointegration has emerged as a promising alternative to rehabilitating with a traditional socket mounted prosthesis. Advantages have been reported to include improved functional mobility, better osseoperception, improved comfort, reduced pain, better biomechanical alignment and better gait, which all lead to a less restricted lifestyle and significantly improved quality of life. A major concern of the Osseointegrated approach lies in the risk of infections occurring from the permanent transcutaneous opening often referred to as the stoma. Several systematic reviews have indicated that the occurrence of minor infections can be quite common, serious complications are reported to be rare. In addition to commonly anticipated complications including fractures, surgical debridements or revisions, we have identified several significant events in which a patient may require to be readmitted and go through additional surgery. The objective of this study is to examine the rate of occurrence and reports on the best management practices of serious complications across a multi-centre review of more than 1000 osseointegration surgeries.Materials & MethodsA detailed analysis has been performed on all osseointegration surgeries performed by the Osseointegration Group of Australia and it's affiliates between since 2010. The majority of surgeries took place in Australia, the United States, the Middle East as well as in Europe. All events leading to a re-admission and subsequent re-operation have been identified through hospital operation records and pooled together for meta-analysis. Events identified include: revision of implants, periprosthetic fracture fixation, surgical debridement due to infections, neurectomies and soft- tissue refashioning.ResultsOver 800 surgeries have been identified with a minimum 12-month follow-up time and included in this study. These included tibial, femoral and humeral, radial-ulnar and transpelvic osseointegration cases. The majority of these were performed using a single stage protocol. While general complications such as infection and soft tissue refashioning are common, serious events such as revision and fracture are rare. Interestingly, the rate of debridements and soft-tissue refashions were found to be higher among patients who were operated using a two-stage surgery. Among all cases, there were a total of 399 re-operation events recorded which occurred among 163 patients, indicating a high recurrence rate among the same patients. We recorded a total of 112 washouts, 93 neurectomies, 117 soft tissue refashions, 53 implant revisions and 24 periprosthetic fracture fixations.ConclusionsMany events leading to readmission after the primary surgery may not necessarily be graded as a complication of the osseointegration technique. This study has identified several addition possible reasons in which an osseointegration patient may need to be re-admitted into hospital for additional surgery. It was identified that through the implementation of improved surgical techniques and rehabilitation protocols, the rate of several of these re-operation events can be largely reduced, thus improving the overall outcomes of patients undergoing osseointegration surgery.

Femoral Head Length Impact on Outcomes Following Total Hip Arthroplasty in 36 Millimeter Cobalt Chrome-on-Highly Crosslinked Polyethylene Articulations

BackgroundDespite concerns for corrosion, dislocation, and periprosthetic femur fractures, minimal literature has investigated the effect of adjusting femoral head length on outcomes after primary total hip arthroplasty (THA). Therefore, we aimed to investigate the effect of femoral head length on the risk of any revision and reoperation following cobalt chromium (CoCr)-on-highly crosslinked polyethylene (HXLPE) THAs. MethodsBetween 2004 and 2018, we identified 1,187 primary THAs with CoCr-on-HXLPE articulations using our institutional total joint registry. The mean age at THA was 71 years (range, 19-97), 40% were women, and mean body mass index was 30 (range, 10-68). All THAs using 36 mm diameter femoral heads were included. Neutral (0 mm), positive, or negative femoral head lengths were used in 42, 31, and 27% of the THAs, respectively. Kaplan-Meier survivorship was assessed. The mean follow-up was 7 years (range, 2-16). ResultsThe 10-year survivorships free of any revision or reoperation were 94 and 92%, respectively. A total of 47 revisions were performed, including periprosthetic femur fracture (17), periprosthetic joint infection (8), dislocation (7), aseptic loosening of either component (6), corrosion (4), and other (5). Nonrevision reoperations included wound revision (11), open reduction and internal fixation of periprosthetic femur fracture (4), and abductor repair (2). Multivariable analyses found no significant associations between femoral head length and revision or reoperation. ConclusionAltering femoral head lengths in 36 mm CoCr-on-HXLPE THAs did not affect outcomes. Surgeons should select femoral head lengths that optimize hip stability and center of rotation. Level of EvidenceIII.

Salvage total hip arthroplasty after failed internal fixation for proximal femur and acetabular fractures

BackgroundTotal hip arthroplasty (THA) is the treatment of choice for posttraumatic arthritis with failed internal fixation for hip fractures. However, the postoperative prognosis is not clear.Questions/purposesThe primary aim of the study is to report the postoperative outcome, prognosis, and complication rates of total hip arthroplasty in posttraumatic hip arthritis after failed internal fixation of fractures around the hip. The secondary aim of the study is to report results among different fracture types around the hip.Patients and methodsWe enrolled salvage THA patients after failed internal fixation of fractures around the hip and matched control patients undergoing primary THA for hip osteoarthritis. Subgroup analysis was performed to compare the postoperative outcomes, prognosis, and complication rates of salvage THA in posttraumatic hip arthritis after failed internal fixation of different fracture types around the hip.ResultsA total of 315 THAs (105 salvage THAs and 210 primary THAs) were analyzed. Patients with salvage THA had a longer operative time, lower postoperative hemoglobin (Hb) level, more Hb drop (2.2 ± 1.4 vs. 1.7 ± 1.2 gm/dl, p = 0.002), and delayed ambulation. The salvage THA group also had a higher dislocation rate within 2 months after salvage THA (9.5% vs. 1.9%, p = 0.002), reoperation rate (10.5% vs. 3.8%, p = 0.019, including debridement, open and closed reduction under sedation, revision surgery, surgical fixation for periprosthetic fractures), and revision rate (5.7% vs. 0.5%, p = 0.003) than patients undergoing primary THA. Patients who had failed fixation for acetabular fractures were younger and tended to recover well. Patients with previous intertrochanteric fracture had the longest operative time, more hip pain (83.8%, p = 0.022) and more complications.ConclusionSalvage THA in posttraumatic hip arthritis after failed internal fixation required a longer operative time and led to more blood loss and postoperative complications. The dislocation, reoperation, and revision rates after salvage THA were higher than those after primary THA. Patients with salvage THA after failed internal fixation for intertrochanteric fractures were the most susceptible to more complications compared to those with femoral neck fracture or acetabular fracture.Level of Evidence level III

Impact of bone health on the mechanics of plate fixation for Vancouver B1 periprosthetic femoral fractures

BackgroundCondyle-spanning plate-screw constructs have shown potential to lower the risks of femoral refractures after the healing of a primary Vancouver type B1 periprosthetic femoral fracture. Limited information exists to show how osteoporosis (a risk factor for periprosthetic femoral fractures) may affect the plate fixation during activities of daily living. MethodsUsing total hip arthroplasty and plate-implanted finite element models of three osteoporotic femurs, this study simulated physiological loads of three activities of daily living, as well as osteoporosis associated muscle weakening, and compared the calculated stress/strain, load transfer and local stiffness with experimentally validated models of three healthy femurs. Two plating systems and two construct lengths (a diaphyseal construct and a condyle-spanning construct) were modeled. FindingsOsteoporotic femurs showed higher bone strain (21.9%) and higher peak plate stress (144.3%) as compared with healthy femurs. Compared with shorter diaphyseal constructs, condyle-spanning constructs of two plating systems reduced bone strains in both healthy and osteoporotic femurs (both applying ‘the normal’ and ‘the weakened muscle forces’) around the most distal diaphyseal screw and in the distal metaphysis, both locations where secondary fractures are typically reported. The lowered resultant compressive force and the increased local compressive stiffness in the distal diaphysis and metaphysis may be associated with strain reductions via condyle-spanning constructs. InterpretationStrain reductions in condyle-spanning constructs agreed with the clinically reported lowered risks of femoral refractures in the distal diaphysis and metaphysis. Multiple condylar screws may mitigate the concentrated strains in the lateral condyle, especially in osteoporotic femurs.

Reoperation and revision rates at ten years after 1,312 cemented Thompson's hemiarthroplasties : any need to change to a different implant?

AimsDespite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes.MethodsPatient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries.ResultsIn total, 1,312 Thompson’s hemiarthroplasties were analyzed (mean age at surgery 82.8 years); 125 complications were recorded, necessitating 82 returns to theatre. These included 14 patients undergoing aspiration or manipulation under anaesthesia, 68 reoperations (5.2%) for debridement and implant retention (n = 12), haematoma evacuation (n = 2), open reduction for dislocation (n = 1), fixation of periprosthetic fracture (n = 5), and 48 revised stems (3.7%), for infection (n = 13), dislocation (n = 12), aseptic loosening (n = 9), persistent pain (n = 6), periprosthetic fracture (n = 4), acetabular erosion (n = 3), and metastatic bone disease (n = 1). Their status at ten years is summarized as follows: 1,180 (89.9%) dead without revision, 34 (2.6%) dead having had revision, 84 (6.6%) alive with the stem unrevised, and 14 (1.1%) alive having had revision. Cumulative implant survivorship was 90.3% at ten years; patient survivorship was 7.4%.ConclusionThe Thompson’s stem demonstrates very low rates of complications requiring reoperation and revision, up to ten years after the index procedure. Fewer than one in ten patients live for ten years after fracture. This study supports the use of a cemented Thompson’s implant as a cost-effective option for frail hip fracture patients.Cite this article: Bone Jt Open 2022;3(9):710–715.

Metal and composite bone plates for B1 periprosthetic femoral fracture in healthy and osteoporotic condition: A comparative biomechanical study.

The major concern after total hip arthroplasty (THA) is the incidence of periprosthetic fracture in the weaker bone, which can lead to subsequent revision surgery. Achieving the suitable fixation without affecting the stability of the well-fixed prosthesis remains controversial. Most of the studies examined the behavior of the Periprosthetic Fracture (PF) fixation (Vancouver "B1" type) through computational and experimentation on healthy bone condition with metal plates. The aim of the present study is to analyze the influences of the metal and composite bone plate PF fixation on the axial and shear movement at the fracture site. The PF fixation constructs were modeled with medical graded stainless-steel plate (construct A), titanium plate (construct B) and carbon/epoxy composite bone plate (construct C) with 12 holes and a 4 mm fracture gap. Analysis was carried out for all the stages (stage 1-Normal bone, stage 2-THA, stage 3-Immediate Post-Operative (IPO), stage 4-Post-Operative (PO) and, stage 5-Healed Bone (HB)) under various loadings for intact and osteoporosis conditions. The results showed higher stress in cortical bone for stage 3, whereas in all the other stages lower stresses were experienced in the cortical and cancelous bone under peak load in construct C for osteoporosis model compared with other constructs. The present study suggested the construct C may be suitable for osteoporosis bone conditions.

Drilling the cement mantle in well-fixed periprosthetic femur fractures is not associated with arthroplasty-related complications.

To determine if screw fixation across a cement mantle is safe and effective during plate fixation of well-fixed periprosthetic femur fractures. Retrospective cohort study. Academic Level I Trauma Center. Twenty-eight patients with AO/OTA 32A[B1] or 32A[C] periprosthetic femur fractures treated with open reduction and internal plate and screw fixation after cemented or uncemented hip arthroplasty. Screw placement into the cement mantle during internal fixation. Primary outcome was revision arthroplasty for aseptic loosening. Secondary outcomes included radiographic evidence of aseptic loosening, infection, nonunion, implant failure, and overall reoperation rate. There were 28 patients who met inclusion criteria. A total of 9 patients had screws placed in the cement mantle while the remaining 19 patients had screws placed around an uncemented stem. At a mean of 3.7-year follow-up, there were no cases of revision arthroplasty or aseptic loosening in either group. There were no significant differences in rates of infection, nonunion, implant failure, or reoperation rate between patients who had screw placement into a cement mantle vs around an uncemented stem. Drilling into the cement mantle during fixation of a periprosthetic femur fracture around a well-fixed cemented hip stem appears safe and effective. When possible, surgeons can consider bicortical screws around a cemented stem, given the biomechanical advantages over unicortical screw or cerclage fixation. Larger prospective trials confirming the safety of this technique are warranted prior to routine implementation. III.

An Assessment of Factors That Influence Outcome Following Fixation of Periprosthetic Distal Femur Fractures Associated with Total Knee Arthroplasty.

Periprosthetic distal femur fractures following total knee arthroplasty (PDFFTKA) are increasingly common [1], mainly in elderly patients with significant co-morbidities [2]. Surgical management usually requires balancing prompt fixation for early mobilization with the need to consider the least physiologically demanding option [3].The aim of this study was to assess predictors of clinical and radiological outcome in patients with PDFFTKA treated with open reduction and internal fixation (ORIF). A retrospective cohort study of patients managed for PDFFTKA over the last 21 years in the Trauma & Orthopaedics Department of the Royal Shrewsbury Hospital (RSH) was carried out. Radiological images, pre- and post-operatively, were assessed for fracture related parameters. Last known functional status was evaluated using the most recent outpatient review letters. After assessment of normality of data, evaluation of predictors of clinical and radiological outcome was made using correlation analyses. There was no statistically significant correlation between age, primary TKA to fracture interval, and length of intact medial cortex vs clinical outcome for the parametric variables evaluated. For non-parametric variables assessed, there was a statistically significant correlation between clinical outcome and evidence of callus formation (Spearman rho value -0.476; p=0.022). In stratifying the patients with poor and good outcome, there was no difference noted in primary TKA to fracture interval, or length of intact medial cortex (mm) between both groups. In terms of the number of comminuted fragments and anterior flange to fracture distance (mm), there was also no difference noted between the poor and good functional groups. 1. There was no observed correlation in pre-operative patient and fracture related variables with outcome in this population of patients with PDFFTKA. 2. Post-operative evidence of callus formation appears to be directly related to better clinical outcomes.

Outcomes After Operative Fixation of Vancouver B2 and B3 Type Periprosthetic Fractures

The incidence of periprosthetic femur fracture in the setting of total hip arthroplasty is steadily increasing. Although the traditional dogma is that loose femoral components must be revised, we propose that in a frail geriatric population, anatomic reduction and fixation of Vancouver B2 and B3 periprosthetic fracture variants can restore stem stability and provide similar outcomes as revision arthroplasty. Retrospective cohort study. Level 1 trauma center, tertiary academic medical center. We identified 94 patients over 65 years of age with Vancouver B2 and B3 fractures sustained between 2005 and 2019. Patients were treated by either open reduction and internal fixation (ORIF) or revision arthroplasty (RA) with or without fixation. Outcomes were mortality, time to full weight-bearing after surgery, intraoperative estimated blood loss, perioperative complications, reoperation, subsidence rate, and Patient-Reported Outcomes Measurement Information System pain and physical function scores. A total of 75 (79.8%) ORIF and 19 (20.2%) RA patients were reviewed. One-year mortality for our cohort was 26.3%, and there was no significant difference between groups. Mean time to weight bear and surgical complication rates were similar between groups. The ORIF group had a significantly shorter time to surgery than the RA group. The RA group had greater incidence and amount of subsidence as well as estimated blood loss than the ORIF group. In geriatric patients with Vancouver B2 and B3 type periprosthetic fractures with known loose stems, ORIF may offer a similarly safe method of treatment than revision arthroplasty. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Periprosthetic Tibial Plateau Fractures After Unicompartmental Knee Arthroplasty Are Successfully Treated With Open Reduction and Internal Fixation.

Periprosthetic tibial fractures after unicompartmental knee arthroplasty (UKA) are rare but devastating events. Given the relative infrequency of these injuries, treatment strategies are not well defined. The goal of this retrospective case series is to report the findings for a series of patients who underwent open reduction and internal fixation (ORIF) of periprosthetic fracture after UKA, including radiographic alignment, Knee Society Score (KSS), and failure rate. Patients were identified by the International Classification of Diseases code for periprosthetic tibial plateau fractures. Electronic medical records and radiographs were retrospectively reviewed. Fracture patterns and coronal and sagittal alignment of UKA components were measured on radiographs. Clinical outcomes, including range of motion assessment, visual analog scale pain score, and KSS, were collected at final follow-up. Eight patients satisfied the inclusion criteria for this study. Fractures occurred at a median of 14 days (range, 5-52 days) after UKA, and all showed a vertical shear pattern that exited at the meta-diaphyseal junction. Of the 8 fractures, 7 (87.5%) healed to radiographic and clinical union after the initial ORIF. One patient required reoperation for hardware failure. Mean visual analog scale pain score and KSS at final follow-up were 3 and 85±14, respectively. Periprosthetic tibial plateau fractures after UKA commonly occur as a vertical shear fracture exiting at the metadiaphyseal junction. The use of ORIF with a 3.5-mm plate in buttress mode is a reliable method for treatment of these fractures. Restoration of alignment and motion is achievable, but residual pain may affect patient-reported outcome scores. [Orthopedics. 2022;45(5):287-292.].

Peri- and Interprosthetic Femoral Fractures-Current Concepts and New Developments for Internal Fixation.

Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal fixation of periprosthetic fractures. Since the elderly are unable to follow partial weight bearing, stable solutions are required. Therefore, a high primary stability is necessary. Numerous options, such as new angular stable plate systems with additional options for variable angle screw positioning, already exist and are in the process of being further improved. Lately, individually produced custom-made implants are offering interesting alternatives to treat periprosthetic fractures.

The Outcome of Fixing Distal Femur Periprosthetic Fracture around Total Knee Replacement using a Locking Plate Non-Contact Bridging (NCB).

Introduction:Surgical fixation of peri-prosthetic distal femur fractures around knee replacements poses a challenge, especially in frail patients, with variable outcomes reported in the literature. This study looks at the outcomes of a consecutive series of patients presenting with such fractures and treated by using a locking plate fixation.Materials and methods:A total of 21 consecutive patients who were admitted to our trauma unit over 31 months and underwent fixation with the Non-Contact Polyaxial Locking plate system were retrospectively identified and their acute treatment with follow-up outcomes were analysed.Results:The mean age was 81 years and 71% were in ASA grades 3 and 4. Fracture morphologies were classified as per the Su classification, yielding 8 (38%) classified as Su one, 4 (19%) as Su two, and 9 (43%) as Su type three. Postoperatively, 2 patients (9.5%) died due to hospital-acquired pneumonia, and another 2 patients (9.5%) developed wound infections necessitating further return to theatre. Additionally, 2 (9.5%) patients had distal femoral replacements due to non-union. Mean discharge time was 28 days with 12 patients (55% of patients) starting protected weight-bearing six weeks after surgery.Conclusion:The incidence of morbidity, mortality was significant and re-operation was required in patients treated as described, and these were partly attributed to the patient’s average age and the pre-existing comorbidities. Significant variations were noted in the time to discharge, rehabilitation, and time to achieve fracture union. However, the majority of fractures did eventually unite. Patients with comminuted fractures and insufficient bone stock are more likely to progress to non-union and end up requiring revision knee arthroplasty.

Clinical and Radiological Outcome of Vancouver B2 Fracture Treated With Open Reduction and Internal Fixation. A Multicenter Cohort Analysis.

To determine whether open reduction and internal fixation (ORIF) of periprosthetic Vancouver B2 fractures can lead to successful fracture healing in selected patients, when attention is given to the surgical exposure and the creation of a balanced extramedullary construct. Retrospective. Two Level-1 trauma centers in Germany and United Kingdom. Patients with a B2 fracture receiving solely ORIF using a polyaxial locking plate were included for analysis. Patients with other fracture types, or treated with other methods, or with follow-up less than 12 months were excluded. Clinical characteristics, including the Charlson index, the American Society for Anesthesiologists score, and their preinjury functional levels, were recorded. Main outcome measures were 1-year mortality, revision rate, and radiological healing according to the Beals-Tower criteria. A total of 32 patients (mean age ,79 ± 12 years) were enrolled. Six patients died within the first year (1-year mortality: 19%), and 5 were unavailable for follow-up studies. The remaining 21 patients had a mean follow-up of 30 months. Of 21, 20 had an excellent/good result using the criteria of Beals-Tower. One patient required revision surgery due to loosening and secondary subsidence of the stem. ORIF can be offered to selected patients suffering from B2 fractures, especially if their functional demand is limited, and perioperative risk high for revision arthroplasty. In this challenging cohort of patients, ORIF was a safe and effective therapeutic option. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.