Circular hexapod external fixation for periprosthetic tibial fracture.
ABSTRACT: A poor soft tissue envelope often accompanies periprosthetic tibia fracture around a well-fixed total knee arthroplasty and the tibial stem leaves little room for screw fixation. This article describes the practicability and effectiveness of a novel surgical technique using circular hexapod external fixation, in patients with this clinical scenario. It was applied for fixation of periprosthetic tibia fracture in 2 patients. Contact between the external fixation pins and the prosthesis was avoided. Using a web-based software program, a gradual reduction in all planes was achieved. Adequate fixation, stability, reduction, and quick healing were obtained in the 2 cases, with minimal complications. The patients returned to their activity level a few months after external fixation removal.
Project description:BACKGROUND:The incidence of periprosthetic fractures after total knee arthroplasty (TKA) is rising due to the increasing number of TKAs performed annually and the growing elderly population. A periprosthetic fracture of the proximal tibia following TKA is a rare injury that may be a challenging clinical scenario. CASE PRESENTATION:The case of an 84-year-old woman who sustained a periprosthetic tibial fracture 10?years after a TKA is presented. This patient had multiple risk factors. The fracture was not deemed amenable to conventional treatment because the bone fragment was too small. This patient underwent fixation of her tibial fracture above the TKA using a five-ring Ilizarov external fixator. This allowed immediate full weight-bearing. The fixator was removed at 12?weeks, at which time the fracture was solidly healed. At the most recent follow-up, 2?years from injury, she was fully weight-bearing without walking aids and had a knee range of motion (ROM) of 0-110°. CONCLUSION:To the best of our knowledge, this is the first report in which Ilizarov external fixation has been used for a periprosthetic tibial fracture after TKA.
Project description:UNLABELLED: Periprosthetic fractures after massive endoprosthetic reconstructions pose a reconstructive challenge and jeopardize limb preservation. Compressive osseointegration technology offers the promise of relative ease of prosthetic revision, since fixation is achieved by means of a short intramedullary device. We retrospectively reviewed the charts of 221 patients who had Compress((R)) devices implanted in two centers between December, 1996 and December, 2008. The mean followup was 50 months (range, 1-123 months). Six patients (2.7%) sustained periprosthetic fractures and eight (3.6%) had nonperiprosthetic ipsilateral limb fractures occurring from 4 to 79 months postoperatively. All periprosthetic fractures occurred in patients with distal femoral implants (6/154, 3.9%). Surgery was performed in all six patients with periprosthetic femur fractures and for one with a nonperiprosthetic patellar fracture. The osseointegrated interface was radiographically stable in all 14 cases. All six patients with periprosthetic fracture underwent limb salvage procedures. Five patients had prosthetic revision; one patient who had internal fixation of the fracture ultimately underwent amputation for persistent infection. Periprosthetic fractures involving Compress((R)) fixation occur infrequently and most can be treated successfully with further surgery. When implant revision is needed, the bone preserved by virtue of using a shorter intramedullary Compress((R)) device as compared to conventional stems, allows for less complex surgery, making limb preservation more likely. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Project description:Periprosthetic femur fractures present a growing worldwide challenge for orthopaedic surgeons. Fractures around a hip resurfacing implant create unique management problems. When considering fixation, there can be limited options for ideal stabilization and some require creative constructs. We present an interesting case of a periprosthetic intertrochanteric femur fracture between a hip resurfacing implant and retrograde intramedullary nail.
Project description:After resection of the radial head, the load transmission through the forearm is changed dramatically. Most of the axial load is transmitted to the ulna. This can happen through the interosseous membrane, if intact, thus preventing proximal migration of theradius. However, radial head resection entails some slacking of the interosseous membrane, thereby reducing its ability to transmit load. In traumatic lesions of the interosseous membrane there is no limit to the proximal migration of the radius until the ulnar head abuts on the carpus. In both cases the load transmitted by the ulna increases dramatically and can promote fractures thereof. A 52-year-old, right-handed male patient presented with a periprosthetic fracture of the right ulna 6 weeks after implantation of an ulna head prosthesis. He had previously undergone radial head excision for malunion of the radial head and secondary humeroradial osteoarthritis. This operation had reduced pain and improved the range of motion at the elbow but entailed degenerative arthritis and related symptoms at the distal radioulnar joint (DRUJ). From the spectrum of possible treatment options, ulnar head resurfacing/hemiprosthesis was elected and performed without intraoperative or postoperative irregularities. However, 6 weeks postoperatively, as he was lifting a heavy object, a periprosthetic fracture of the ulna occurred, which ultimately was treated successfully by open reduction and plate fixation. Plate fixation of periprosthetic fractures is an established treatment concept after excluding implant loosening. Periprosthetic fracture of the ulna seems to be a rare complication but can be treated similarly.
Project description:Periprosthetic distal femoral fractures are occurring in increasing numbers. There is limited research into outcomes and mortality. This study aimed to assess the 1 year mortality and complications requiring further surgery in the two years following a presentation with a periprosthetic distal femoral fracture. A retrospective case series of periprosthetic distal femoral fractures at a single trauma centre was undertaken. All patients were included who presented with a distal femur periprosthetic fracture between 1st January and 2008 and 31st March 2015. 60 patients with 49 females and 11 males. Mean age was 80.7. Median time to surgery was 63?h 42 (70%) underwent open reduction internal fixation, 13 (21.7%) underwent revision arthroplasty and 5 (8.3%) underwent non-operative treatment. Median length of stay was 14 days. There were 12 (20%) complications requiring further surgery within 2 years. There were 2 (3.3%) deaths in 30 days and 8 (13.3%) within 1 year following fracture. Periprosthetic distal femoral fractures are becoming a common orthopaedic presentation. They occur in a complex group of patients and have high rates of mortality and complications.
Project description:The present study aimed to investigate the prevalence and clinical consequences of occult intra-operative periprosthetic femoral fractures in total hip arthroplasty (THA). Between 2012 and 2017, a total of 113 primary THAs were enrolled. The mean age of the patients was 66.4 ± 7.6 years. We assessed occult intra-operative periprosthetic femoral fractures with the use of computed tomography (CT) and risk factors, including age, sex, body mass index, diagnosis, stem size, and radiographic parameters of proximal femoral geometry were analyzed. We also assessed the differences in thigh pain and stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. Occult intra-operative periprosthetic femoral fractures were found in 13 of 113 hips (11.5%). In 9/13 (69.2%) of occult fractures, fracture lines were started from the region below the tip of the lesser trochanter. Six periprosthetic femoral fractures (5.3%) were found during the operation. Out of the five hips that had detected femoral fractures around the lesser trochanter intra-operatively, four hips (80%) showed concurrent occult fractures on different levels. The female sex (P = .01) and canal filling ratio at 7 cm below the tip of the lesser trochanter (P = .01) were significantly different between the patients with and without occult periprosthetic femoral fracture. The sex was significantly associated with an increased risk in predicting an occult intra-operative periprosthetic femoral fracture (odds ratio of male, 0.25 compared with the female; 95% CI, 0.08-0.85; p = .02). There was a significant difference in the incidence of thigh pain between occult fracture group and non-occult fracture group (P < .05). There were no significant differences in stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. All 13 cases of occult intra-operative periprosthetic femoral fractures were healed at the final follow-up. Occult periprosthetic femoral fractures are common during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA, that CT scans are helpful to identify them, and that these fractures do not adversely affect the implant's survival if a rigid fixation of the implants has been achieved.
Project description:BACKGROUND:Atypical femoral fracture is one of the many complications after the long-term use of bisphosphonates. The American Society for Bone and Mineral Research has officially excluded periprosthetic femoral fractures (PFFs) from the definition of atypical femoral fractures (AFFs). Several case reports found that PFFs can occur with characteristics similar to those of AFFs. The purpose of our study was to evaluate the proportion of atypical fractures among Vancouver type B1 fractures, and to determine the association between the long-term use of bisphosphonates and the occurrence of atypical periprosthetic femoral fractures (APFFs). METHODS:In this retrospective study, we reviewed 41 patients with Vancouver type B1 periprosthetic fractures between January 1, 2011 and December 31, 2018. We classified them into two groups, namely atypical and typical PFFs, based on the fracture morphology. We noted the proportion of atypical periprosthetic fractures among B1 fractures and identified risk factors. RESULTS:Among the 41 PFFs, 5 (13%) fractures were classified as atypical PFF based on the radiological characteristics. The longer duration of bisphosphonate use was probably the only independent risk factor that significantly increases the occurrence of APFF (p?=?0.03, 0.08 (CI 0.008 - 0.16)). There were no significant differences in age, gender, body mass index, comorbidities, corticosteroid use, positioning of the femoral stem, the method of fixation (cemented or cementless) and time lapse from before the primary prosthesis implantation to the PFF in the development of atypical fracture type. CONCLUSIONS:There seems to be a correlation between the long-term intake of bisphosphonates and the atypical periprosthetic fracture. Atypical femoral fracture can also occur in the periprosthetic form. TRIAL REGISTRATION:Study number: 22/2019-SZTE, http://www.klinikaikutatas.hu/hu/kutatasetika/jovahagyott-vizsgalatok-koezerdeku-adatai/category/25-jovahagyott-vizsgalatok-kozerdeku-adatai-rkeb-2019.html?download=985:22-2019 .
Project description:The use of hexapod circular external fixators has simplified the ability to correct complex limb deformities without cumbersome frame reconfigurations. These frames are applied primarily using half pin mountings and may be difficult to utilize given the constraints of traditional half pin constructs. We compared the biomechanical performance of simplified divergent half pin frames to mountings currently being utilized for application of hexapod frames. Three 6-mm half pins per limb segment were placed into sawbones at 60 degree divergent angles in both the sagittal and coronal planes in a 2-cm diaphyseal fracture gap model. Pin mountings were attached to a standardized four-ring construct. This was compared to similar four-ring frames with two differing pin/wire configurations: (1) two tensioned wires per ring placed at 90 degree angles, a total eight wires; and (2) two 5-mm half pins per ring placed at 90 degree angles, a total eight half pins. The divergent 6-mm half pin frames demonstrated similar performance compared the standardized tensioned wire and 5-mm half pin frames in terms of axial micromotion and angular deflection. Based on the mechanical performance of these divergent half pin frames we believe they can be used clinically without detrimental consequences.
Project description:A 74-year-old male presented with acute right knee pain and inability to ambulate. The patient had a total knee arthroplasty, previously complicated by a periprosthetic femur fracture requiring surgical fixation and subsequent methicillin-resistant <i>Staphylococcus epidermidis</i> periprosthetic joint infection treated via two-stage revision. Cultures from knee fluid aspiration were positive for <i>Abiotrophia defectiva</i>. Identification was confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The patient underwent a two-stage revision. Between stages, the patient received intravenous ceftriaxone for six weeks with subsequent normalization of inflammatory markers. Diagnosis of periprosthetic joint infection with identification of the organism is important to guide appropriate treatment.
Project description:Background and purpose - The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Registry studies have indicated an increased risk of revision of uncemented implants due to early periprosthetic femoral fracture. In this paper, we describe the incidence and predisposing factors for intraoperative and early postoperative (? 90 days) periprosthetic femoral fractures after cemented and uncemented THA. Patients and methods - This was a prospective observational study in 8 Danish high-volume centers from February 2010 to November 2013. We used the 90-day follow-up from the Danish National Patient Registry and patient records. We obtained intraoperative information from the Danish Hip Arthroplasty Registry and from surgical notes. Results - Of 7,169 primary consecutive THAs, 5,482 (77%) were performed using uncemented femoral components. The total incidence of periprosthetic femoral fractures ? 90 days postoperatively was 2.1% (n = 150). 70 fractures were detected intraoperatively (46 required osteosynthesis). 51 postoperatively detected fractures occurred without trauma (42 of which were reoperated) and 29 were postoperative fall-related fractures (27 of which were reoperated). 134 fractures (2.4%) were found in uncemented femoral components and 16 (0.9%) were found in cemented femoral components (p < 0.001). Uncemented femoral stem (relative risk (RR)?=?4.1, 95% CI: 2.3-7.2), medically treated osteoporosis (RR =2.8, CI: 1.6-4.8), female sex (RR =1.6, CI: 1.1-2.2), and age (RR =1.4 per 10 years, CI: 1.2-1.6) were associated with increased risk of periprosthetic femoral fracture when analyzed using multivariable regression analysis. Interpretation - Uncemented femoral components were associated with an increased risk of early periprosthetic femoral fractures, especially in elderly, female, and osteoporotic patients.