Type B1 Periprosthetic Femoral Fractures Research Articles

Clinical effect of cemented long stem prosthesis and memory alloy embracing fixator in the treatment of type B2 periprosthetic fractures

Objective To study the clinical effect of cemented long stem prosthesis and memory alloy embracing fixator in the treatment of type B2 periprosthetic fractures. Methods Fom April 2014 to April 2016, 102 cases of peripheral B2 periprosthetic fractures patients were selected and randomly divided into bone cement long stem prosthesis revision surgery(group A) and revision of cemented long stem prosthesis combined with memory alloy embracing fixator( group B), each group with 51 cases.Clinical efficacy was evaluated according to Beals and Tower criteria, used Harris score to evaluate the hip the joint function, used the Visual Analogue Scale(VAS) score to evaluate the pain, after follow-up of 40 months, the clinical curative effect of 2 groups of patients, fracture healing time, complications and Harris score and VAS score were observed. Results The excellent rate of B group was significantly higher than that of A group, with statistical significance(90.2% vs.72.5%, χ2=5.239, P<0.05). Fracture healing time of group B was shorter than that of group A, with statistically significant ((10.2±2.5) weeks vs.(21.3±8.9) weeks, t=8.575, P<0.05). Harris the score of group B was higher than the group A, with statistically significant((89.9±13.5) points vs.(71.2±18.9) points, t=5.750, P<0.05). VAS score of group B was significantly lower than the group A, with statistically significant((1.23±0.25) points vs.(5.98±1.08) points, t=30.600, P<0.05). There were no complications such as infection, nonunion, loss of reduction and loosening of internal fixation in the 2 groups. Conclusion Revision of cemented long stem prosthesis combined with memory alloy embracing fixator is an ideal methods for the treatment of type B2 periprosthetic femoral fractures, which provides a good initial stability for fracture healing. Key words: B2 periprosthetic fracture; Revision of cemented long stem prosthesis; Memory alloy embracing fixator; Clinical efficacy

Effectiveness of operative interventions for hemi or total hip arthroplasty patients who sustain a Vancouver B2 peri-prosthetic femoral fracture: a systematic review protocol.

The objective of this review is to identify the effectiveness of operative interventions for individuals who have undergone a hemi or total hip arthroplasty who sustain a Vancouver type B2 peri-prosthetic femoral fracture or equivalent. Specifically, this review will investigate open reduction and internal fixation and femoral revision arthroplasty with or without internal fixation.

Surgery of Vancouver Type B2 Periprosthetic Femoral Fracture after Total Hip Arthroplasty in Elderly Patients: An Alternative way with Internal Fixation

Surgery of Vancouver Type B2 Periprosthetic Femoral Fracture after Total Hip Arthroplasty in Elderly Patients: An Alternative way with Internal Fixation

High union rates of locking compression plating with cortical strut allograft for type B1 periprosthetic femoral fractures.

Unified classification system (UCS) type B1 periprosthetic femoral fractures are associated with many complications, and management decisions continue to be controversial. The purpose of this study was to evaluate outcomes of UCS type B1 periprosthetic femoral fractures treated by locking compression plating with strut allograft augmentation. We retrospectively reviewed 17 consecutive UCS type B1 periprosthetic femoral fractures treated by open reduction and internal fixation using a lateral locking compression plate supplemented with an anterior cortical strut allograft. There was one man and 16 women with an average age of 74years (range, 57-92years). All had a cementless hip arthroplasty, and eight of the arthroplasties were revisions. The mean duration of follow-up was 28months (range, 12-74months). All 17 fractures healed successfully at a mean of 20weeks (range, 12-30weeks). The mean post-operative Harris hip score was 86 points (range, 77-95 points). No mechanical complications such as failure of plate or screws and malalignment were noted. According to the graft-remodeling classification of Emerson et al., a partial bridging was observed in nine and a complete bridging in eight. Two patients required a removal of the plate due to irritation of the iliotibial band. No femoral stem loosening or deep infection was observed. Our findings indicate that open reduction and internal fixation of UCS type B1 periprosthetic femoral fractures using a lateral locking compression plate supplemented with anterior cortical strut allograft provides adequate mechanical stability of fracture fixation and enhances the fracture healing.

Biomechanical study of improved memory alloy embracing fixators in treatment of periprosthetic femoral fracture due to hip arthroplasty

Objective To study the mechanics of improved memory alloy fixators for salvage of periprosthetic femoral fracture (PFF) after hip arthroplasty in the elderly. Methods Thirty countrymen fresh cadaveric femurs with no pathological defect, fracture, deformity or tumor were randomly divided into experimental group and control group with 15 femurs in each according to the random number table. A model of Vancouver type B1 periprosthetic femoral fracture following hip arthroplasty was induced. The fracture was treated with modified memory alloy embracing fixators in experimental group; instead general memory alloy embracing fixators in control group. All specimens were tested biomechanically. Results Under the same mechanical loading, the two groups showed respective 30% and 48% maximum differences in stress value and displacement. Results in three-point bending test did not differ significantly between the two groups (P>0.05), but there were significant differences in axial compression and torsion test (P<0.05 or 0.01). Conclusion The improved memory alloy embracing fixators present better resistance to compression and torsion compared to the general fixators. Key words: Internal fixators; Arthroplasty, replacement, hip; Periprosthetic fractures; Memory, alloy

The management of type B1 periprosthetic femoral fractures: when to fix and when to revise.

The incidence of periprosthetic fractures around total hip arthroplasty is increasing as patient longevity rises and the number of patients with hip implants continues to grow. Type B1 periprosthetic femoral fractures are associated with a well-fixed stem and have traditionally been treated with internal fixation. However, there are a subset of these fractures which fare badly when internal fixation is undertaken, and revision of the femoral component to a long-stemmed implant may be more appropriate. We look at the traditional methods of fixation, and the evidence and indications for revision of these fractures.

Periprosthetic Femoral Fracture — A Biomechanical Comparison Between Vancouver Type B1 and B2 Fixation Methods

Current clinical data suggest a higher failure rate for internal fixation in Vancouver type B1 periprosthetic femoral fracture (PFF) fixations compared to long stem revision in B2 fractures. The aim of this study was to compare the biomechanical performance of several fixations in the aforementioned fractures. Finite element models of B1 and B2 fixations, previously corroborated against in vitro experimental models, were compared. The results indicated that in treatment of B1 fractures, a single locking plate can be without complications provided partial weight bearing is followed. In case of B2 fractures, long stem revision and bypassing the fracture gap by two femoral diameters are recommended. Considering the risk of single plate failure, long stem revision could be considered in all comminuted B1 and B2 fractures.

Percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO): a percutaneous reduction technique in the treatment of Vancouver type B1 periprosthetic femoral shaft fractures

Periprosthetic femoral fractures (PPFs) associated at or near a well-fixed femoral prostheses (Vancouver type-B1) present a clinical challenge due to the quality of the bone stock and instability of the fracture. The purpose of this study was to present a novel reduction technique and analyze clinical and radiographic outcome in patients with Vancouver type-B1 fractures treated with percutaneous cerclage wiring for fracture reduction and maintenance of reduction with minimally invasive plate osteosynthesis (MIPO) utilizing a locking compression plate (LCP). Between March 2007 and December 2008, ten consecutive patients with spiral, oblique or wedge Vancouver type-B1 were treated with closed percutaneous cerclage wiring using a new cerclage passer instrument (Synthes) through small 2-3 cm incisions for reduction and maintenance of reduction. Internal fixation with MIPO was obtained utilizing a long LCP Synthes bridging the fracture. The reduction time, fixation time and operative time were recorded. The rehabilitation protocol consisted of partial weight bearing as tolerated. Clinical and radiographic outcomes included evidence of union, return to pre-injury mobility, and surgical complications were recorded. There were three men and seven women with an average age of 74 years (range 47-84 years) at the time the fracture occured. The average follow-up was 13.2 months. One patient died 2 months after surgery due to cardiovascular problems and was excluded. The average reduction time with percutaneous cerclage wiring was 24.4 min (range 7-45 min). The average fixation time was 79 min (range 53-100 min). The average operative time was 103 min (range 75-140 min). Blood loss was minimal and only two patients needed a blood transfusion. All fractures healed with a mean time to union of 18 weeks (range 16-20 weeks). There was one implant which bent 10° in the post-operative period but went on to heal uneventfully within 16 weeks. There was no evidence of loosening of any implants. Seven patients returned to their previous level of mobility. Two patients required a walker. There were no implant failures, wound complications or infections. Percutaneous reduction of spiral, oblique or wedge-type B1 PPFs with percutaneous cerclage wiring combined with minimally invasive locking plate osteosynthesis provided satisfactory reduction, adequate stability and healing in nine patients. Our early results suggest that this reduction technique and fixation may be a useful solution for this growing challenge in orthopaedics. The authors caution that this technique must be done carefully to avoid serious complications, e.g., vascular injury.

Results of Cemented Femoral Revisions for Periprosthetic Femoral Fractures in the Elderly

The treatment goals of Vancouver type B2 periprosthetic femoral fractures in elderly patients with a limited life expectancy are early weight bearing without compromising the fracture healing. Thirty-one patients with a mean age of 82 years were treated with a long cemented stem with additional allograft or plate fixation, followed by immediate full weight bearing. Seven major complications occurred within the first 3 months postoperatively. Forty-three percent of patients had died within the first year with their implant in place. Sixteen patients had survived more than 1 year. None of the implants had to be revised at a mean follow-up of 46 months. The results of this series suggest that this technique can provide acceptable results and offers the advantages of reduced cost and early weight bearing.

Locking Compression Plate and Cerclage Band for Type B1 Periprosthetic Femoral Fractures: Preliminary Results at Average 30-Month Follow-Up

We present results of 12 type B1 periprosthetic femoral fractures treated with locking compression plate and cerclage band from January 2003 to June 2007. The average follow-up was 30.1 months. Twelve fractures united in an average period of 4.8 months. The mean Harris hip score was 84.4. One patient presented with loosening of proximal screws at 5 months. This patient was treated nonoperatively as she had radiographic evidence of fracture union. One patient with delayed union required 9 months to heal. Unfortunately, 1 month later, she sustained a type C fracture during a slipping injury and treated with cast immobilization. The fracture united after 4 months. None had complications of loss of reduction, plate break, and wound infection.

Isolated locked compression plating for Vancouver Type B1 periprosthetic femoral fractures

Objective Report treatment results of periprosthetic femoral fractures adjacent or at the tip of a stable femoral stem (Vancouver Type B1) using a locked compression plate as the sole method of fracture stabilisation. Design Retrospective case series. Setting Academic Level I Trauma Centre. Patients Patients operatively treated at our institution with locked compression plating for Vancouver Type B1 periprosthetic fractures between 2002 and 2006 with at least 12 weeks of clinical follow-up were included. Patient demographics, hip arthroplasty implant characteristics, and AO/OTA fracture type were recorded. Intervention Open reduction internal fixation using a locked-plate spanning a majority of the femur through a lateral soft-tissue sparing approach. No cortical onlay allografts or cerclage devices (wires or cables) were used. Main outcome measurements Clinical union was defined at a minimum of 12 weeks as ability to walk, with or without the use of a walking aide, without pain at or around the fracture site. Radiographic union was defined by bridging bone spanning two or more cortices on orthogonal radiographs of the femur. Results Ten subjects met the inclusion criteria and were followed for a mean of 27 weeks (range 14–97 weeks). All achieved fracture union at a mean of 17 weeks (range 12–27 weeks). There were no hardware failures or changes in fracture alignment from operative radiographs. There were no major complications that necessitated reoperation. Conclusions Open reduction internal fixation of Vancouver Type B1 periprosthetic femoral fractures using a lateral locked-plate that spans the full extent of the femur as the sole method of stabilisation is a successful treatment method that minimises soft-tissue dissection and provides adequate fixation strength to maintain fracture alignment to fracture union.

Fixation of Periprosthetic Femoral Shaft Fractures Adjacent to a Well-Fixed Femoral Stem With Reversed Distal Femoral Locking Plate

Numerous fixation methods have been described for the fixation of Vancouver type B1 periprosthetic fractures, but there have been a very few reports in the literature regarding the use of locking plates and their outcomes for this fracture. The objective of this study was to analyze clinically and radiographically, the results of fixation of Vancouver type B1 periprosthetic femoral fractures with a reversed distal femoral locking plate. Thirteen consecutive patients with Vancouver type B1 periprosthetic femoral fracture were stabilized with reversed distal femoral locking plate. Patients were followed up at 2, 6, 12, 24, and 48 weeks and yearly thereafter. They were assessed clinically and radiographically for union, delayed union, malunion, hardware failure, nonunion, infection, and stability of the femoral prosthesis. The average duration of follow-up was 18 months. All fractures healed at an average of 14 weeks from fixation. Complications include superficial wound infection in one and flare-up of previous infection in one with union at 20 and 28 weeks, respectively. Twelve femoral prostheses were stable and all patients were ambulatory, with or without a walking aid at final follow-up. There was no hardware failure or nonunion. Reversed distal femoral locking plate treatment is a feasible and effective choice for stabilization with femoral stem retention after Vancouver type B1 periprosthetic femoral fracture in an elderly patient population.

The use of uncemented extensively porous-coated femoral components in the management of Vancouver type B2 periprosthetic femoral fractures

To assess the outcome of patients with Vancouver type B2 periprosthetic fractures treated with femoral revision using an uncemented extensively porous-coated implant. From October 2002 to May 2007, a retrospective clinical and radiographic assessment of 10 patients with Vancouver type B2 periprosthetic fractures treated with femoral revision was evaluated, among which 4 was cement fixation, 6 was non-cement fixation in the index procedure. The mean follow-up for these patients was 44 months (range, 12 to 67 months). The mean Harris hip score was 87.6 points. All 10 reconstructions showed solid fracture union and a stable prosthesis, 8 was bone ingrowth, 2 was fibrous ingrowth. Complications in 4 patients included thigh pain in 1, stress shield in 3. Vancouver type B2 periprosthetic fractures treated with uncemented extensively porous-coated femoral stems incorporate distally allowing stable fixation.

Locking Compression Plate Fixation of Vancouver Type-B1 Periprosthetic Femoral Fractures

Fractures occurring at or near the distal tip of a hip prosthesis with a stable femoral stem (Vancouver type-B fractures) are associated with many complications because of the inherently unstable fracture pattern. Locking compression plates use screws that lock into the plate allowing multiple points of unicortical fixation. Such unicortical fixation may lower the risk of damage to the cement mantle or a stable femoral stem during the treatment of a periprosthetic femoral fracture. The purpose of this study was to analyze clinically and radiographically a group of patients with a Vancouver type-B1 periprosthetic femoral fracture treated with open reduction and internal fixation with use of a locking compression plate. Fourteen consecutive patients (fourteen hips) with a Vancouver type-B1 periprosthetic femoral fracture were treated with a locking compression plate. There were five men and nine women with an average age of sixty-eight years at the time of fracture. All of the fractures occurred after a total hip arthroplasty performed with cement, and eleven of the arthroplasties were revisions. In addition to the plate, cortical strut allografts were used to stabilize five fractures. The patients were assessed clinically and radiographically. The average duration of follow-up was twenty months. Eight fractures healed uneventfully at an average of 5.4 months. Three treatment constructs failed with fracture of the plate within twelve months after surgery. An additional three constructs also failed because of plate pullout. All failures except one occurred in constructs in which a cortical strut allograft had not been utilized. On the basis of the high failure rate in this series of patients, locking compression plates do not appear to offer advantages over other types of plates in the treatment of type-B1 periprosthetic femoral fractures. Despite the potential to preserve the cement mantle, the locked screws did not appear to offer good pullout resistance in this fracture type. We believe that supplementation with strut allografts should be used routinely if this type of locking compression plate is selected to treat these fractures.

Outcome following stabilization of type B1 periprosthetic femoral fractures

We present results of internal stabilization of 16 type B1 periprosthetic femoral fractures following total or hemiarthroplasty of the hip. Seven patients had cemented stems, and the rest had cementless, extensively hydroxyapatite-coated stems. Fourteen were managed by a cable-grip plating system, 1 by Dynamic compression plate, and 1 had insertion of cables only. Minimum follow-up was 1 year. Four patients had a major complication: 2 had deep infection; 1 had nonunion requiring amputation; and 1 had persistent hip pain requiring removal of all metalwork, including the hip prosthesis. The average time to healing in the remaining patients was 16.3 weeks. Harris Hip Scores dropped from an average of 86.8 preoperatively to 73.4 on last follow-up. Periprosthetic fractures are a significant injury, with a high risk of complications.

EVOLUTION OF THE INTERNAL FIXATION OF LONG BONE FRACTURES

EVOLUTION OF THE INTERNAL FIXATION OF LONG BONE FRACTURES