Periprosthetic fractures of the femur are among the most serious complications in hip surgery. Various classifications have been suggested. At present the Vancouver classification system probably comes closest to the ideal. Most authors recommend internal fixation of the fractures in well-fixed implants (Vancouver type B1). However as the fixation to the proximal fragment has always been a problem, many types of fixation devices have been used. This retrospective study was done to evaluate the efficacy of an LC-DCP with trochanteric purchase, in the fixation of Vancouver type B1 periprosthetic femoral fractures. Our study included 12 patients, 7 male and 5 female with a mean age of 73 years (range: 57 to 91). One patient died due to complications not related to surgery and in another patient the plate was found broken with a loose implant, which was revised. All cases were primary arthroplasties. A long broad LC-DCP was used for the fixation. Purchase in the proximal fragment was obtained with screws in the greater trochanter. Ten fractures united in an average period of 7 months. The mean duration of follow-up was 6.5 years. The final results were evaluated using the Harris hip score. The mean Harris hip score was 85 with a range of 75 to 94.
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J Bone Joint Surg Am
January 2025
Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, West Yorkshire, England.
Background: In this study, we estimated the risk of surgically treated postoperative periprosthetic femoral fractures (POPFFs) associated with femoral implants frequently used for total hip arthroplasty (THA).
Methods: In this cohort study of patients who underwent primary THA in England between January 1, 2004, and December 31, 2020, POPFFs were identified from prospectively collected revision records and national hospital records. POPFF incidence rates, adjusting for potential confounders, were estimated for common stems.
J Orthop Surg Res
January 2025
Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Background: Transfemoral osseointegrated prostheses, like other uncemented prostheses experience the risk of aseptic loosening and post-operative periprosthetic fractures, with an incidence between 3% and 30%. To date, however, osseointegrated off-the-shelf prostheses are manufactured in a limited number of sizes, and some patients do not meet the strict eligibility criteria of commercial devices. A customized osseointegrated stem was developed and a pre-clinical in vitro investigation of the stem was performed, to evaluate its biomechanical performance.
View Article and Find Full Text PDFJ Clin Orthop Trauma
March 2025
Department of Orthopaedic Surgery, Mercy St. Vincent Medical Center, 2213 Cherry St., Toledo, OH, 43608, USA.
Background: Gravid females with pelvic fractures are rarely encountered by the orthopaedic trauma surgeon. The initial injury can be detrimental to the pregnant patient, but an unnecessary "second hit" from surgery could also contribute to the outcome of the fetus. Understanding the surgical risks for this unique patient population requires knowledge about the negative effects of anesthesia, surgical exposures, and radiation.
View Article and Find Full Text PDFMedicina (Kaunas)
January 2025
Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea.
Managing periprosthetic femoral fractures is challenging, particularly in osteoporotic patients with fragile bones. Revision with a long stem is commonly considered but may fail to provide adequate fixation and stability in fragile bones. A novel approach using sandwiched strut allografts and controlled bone crushing with robust cable fixation can offer mechanical support and provide secondary stability to the loosened femoral stem and can be considered a treatment option for low-demand patients.
View Article and Find Full Text PDFMedicina (Kaunas)
January 2025
Department of Orthopedics and Traumatology, Karabük University, Karabük 78050, Turkey.
The study aimed to evaluate a newly designed semicircular implant for the fixation of Vancouver Type B1 periprosthetic femoral fractures (PFFs) in total hip arthroplasty (THA) patients. To determine its strength and clinical applicability, the new implant was compared biomechanically with conventional fixation methods, such as lateral locking plate fixation and a plate combined with cerclage wires. : Fifteen synthetic femur models were used in this biomechanical study.
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