Exploration of the treatment for the periprosthetic femoral fractures

Abstract

Abstract: Objective and Methods To in vestigate the clinical value of the different managements of periprosthetic femo ral fractures (PFF). A retrospective study of 16 cases with PFF fixed respectiv ely with cable, plates and screws, encircling device and altered long stem pros thesis was undertaken.Results Clinical and functional results were followed-up from 4 to 14 months with an average of 6 months. All the fractures were healed with excellent functional recoveries. Three of these cases scored above 90; 9 c ases scored 80 to 89; 3 cases scored 70 to 79; and 1 case scored 63 according to the functional evaluation. The success rate of these treatments was 75%. Conclusions Different types of PFF should be treated with different methods. Cablewith stainless steel cerclage was used for fissure fracture from the femoral neck to lesser trochanter; a smaller type of prosthesis was grafted and then fixed with the cable for complete fissure fracture; longer prosthetic stem graft repla cement ac-companied by cable fixation, and locked nailing or encircling devices for distant part of the graft, were recommended for frac-tures happened from inf erior edge of lesser trochanter to superior margin of narrowed segment of femora l stem. Steel plate or encircling devices fixation with bone graft is suitable for fractures occurred on inferior part of narrowed segment of femoral stem mar row.

CLC Number:

R68.7

ZHA Zhen-gang¹, LIN Hong-sheng¹. Exploration of the treatment for the periprosthetic femoral fractures[J]. Journal of Southern Medical University, 2004, 24(01): 91-93.

References

[1] Schwartz JT JR,Mayer JG,Engh CA. Femoral fracture during noncemented total hip arthroplasty[J]. J Bone Joint Surg Am,1989,71(8):1135-42.
[2] Christensen CM,Seger BM,Schultz RB. Management of intraoperative femur fractures associated with revision hip arthroplasty[J].Clin Orthop,1989,(248):177-80.
[3] Mont MA,Maar DC,Krackow KA,et al. Hoop-stress fractures of the proximal femur during hip arthroplasty:Management and results in 19 cases[J]. J Bone Joint Surg,1992,74(2):257-60.
[4] 刘玉杰,卢世璧,刘保卫,等.人工髋关节置换术并发股骨骨折临床分析[J].中华外科杂志,1 998,36(2):93-5.Liu YJ,Lu SB,Liu BW,et al. The reason and management of intraoperative femur fracture during hip arthroplasty[J]. Chin J Surg,1998,36(2):93-5.
[5] Kavanagh BF. Femoral fracture associated with total hip arthroplasty[J]. Orthop Clin of North Am,1992,23(2):249-57.
[6] 股骨头缺血性坏死专题讨论纪要[J].中华外科杂志,1994,32:549.Recorded sumumary of discussion on the special issue of ischemic necrosis of femoral head[J]. Chin J Surg,1994,32:549.
[7] Andrew TA,Flanagan JP,Gerundini M,et al. The isoelastic noncemerited total hip arthroplasty:preliminary experience with 400 cases[J]. Clin Orthop,1986,(206):127-38.
[8] Bethea JS,Dandraed JR,Fleming LL,et al. Proximal femoral fractures following total hip arthroplasty[J]. Clin Orthop,1982,(170):95-106.
[9] Uchio Y,Shu N,Nishikawa U,et al. Mennen plate fixation for fraetures of the femoral shaft after ipsilateral hip arthroplasty[J]. J Trauma,1997,42(6):1157-60.
[10] Otremski I,Nusam I,Glickman M,et al. Mennen paraskeletal plate fixation for fracture of the femoral shaft in association with ipsilateral hip arthroplasty[J]. Injury,1998,29(6):421-3.
[11] Haddad FS,Marston RA,Muirhead-Allwood SK. The Dall-Miles cable and plate system for periprosthetic femoral fractures[J]. Injury,1997,28(7):445-7.
[12] Kamineni S,Vindlacheuvu R,Ware HE. Peri-prosthetic femoral shaft fractures treated with plate and cable fixation[J]. Injury,1999,30(4):261-8.
[13] Kamineni S,Ware HE. The Mennen plate:unsuitable for elderly femoral peri-prosthetic fractures[J]. Injury,1999,30(4):257-60.
[14] Petersen VS. Problems with the Meunen plate when used for femoral fractures associated with implants. A report of 5 patients[J]. Int Orthop,1998,22(3):169-70.
[15] Noorda R P,Wuisman PJ. Mennen plate fixation for the treatment of periprosthetic femoral fractures[J]. J Bone Joint Surgery,American Volume,2002,84(12):2211-6.
[16] Frankie Leung,项舟.锁定加压钢板治疗人工关节假体周围骨折[J].中国修复重建外科杂志,2002,16(2):123-5.Frankle Letmg,Xiang Z. Locking compression plate fixation for periprosthetic femoral fracture[J]. Chung Kuo H-siu Fu chung Chian Wai Ko Tsa Chih,2002,16(2):123-5.
[17] Ko PS,Lam J J,Tio MK,et al. Distal fixation with Wagner revision stem in treating Vancouver type B2 periprosthetic femur fractures in geriatric patients[J]. J Arthroplasty,2003,18(4):446-52.