New classification focusing on implant designs useful for setting therapeutic strategy for periprosthetic femoral fractures

Abstract

Our classification is based on a completely new concept and was prepared to overcome periprosthetic femoral fracture failures by objective evaluation. We believe this new classification is useful to establish a therapeutic strategy for femoral fractures around the stem.

Periprosthetic fractures of the proximal femur: beyond the Vancouver classification

“…In this article we have combined our own concept with steps published by various authors into an algorithm in the hope of achieving better diagnosis of periprosthetic fractures of the proximal femur. 5 , 22 , 23 , 29 In fracture management, it is generally accepted that Vancouver B1 fractures should be treated with ORIF alone, and that Vancouver B2 fractures should be revised. Although the differentiation between Vancouver B1 and B2 fractures seems straightforward, it has been suggested that the actual rate of stem loosening may be underestimated, resulting in patients who should have been treated with revision being treated with ORIF.…”

“…In agreement with this presumption, the data from a Swedish hip registry showed that up to 47% of stems in periprosthetic fracture are ‘unknown loose’, meaning that the surgeon found the stem to be loose only during the revision – clearly, a better clinical and radiologic criteria to detect stem loosening is needed. 1 , 23 In this manuscript, we combined the concepts from Baba et al 29 and Ninan et al 23 with our own, and constructed an algorithmic approach to identify loose stems around periprosthetic fractures using patient history, stem design, and plain radiographs.…”

New fracture pattern focusing on implant fracture for periprosthetic femoral fractures

“…Periprosthetic femoral fracture after THA is an uncommon but increasing clinical problem [1][2][3][4][5][6][7][8][9][10]. According to the Swedish National Hip Arthroplasty register, the estimated incidence of periprosthetic femoral fractures following primary THA is 0.4 %, while that after revision arthroplasty is 2.1 % [5].…”

“…Periprosthetic femoral fracture after total hip arthroplasty (THA) is an increasing clinical problem [1][2][3][4][5][6][7][8][9][10] and the third most frequent reason for revision following primary THA after aseptic loosening and sepsis [1,11]. Periprosthetic fractures are difficult to manage and may have a poor outcome, and the treatment of periprosthetic fractures of the femur after THA in particular remains a surgical challenge [3-6, 12, 13].…”

Financial contributions to global surgery: an analysis of 160 international charitable organizations

“…To further contextualize, in 2013, 77,350 major surgical interventions were performed, but in that same year 2,497,250 measles vaccinations delivered, there were 9,029,100 outpatient consultations, and 341,600 patients were enrolled in HIV care (MSF 2013 ). Additionally, independent studies have shown that MSF also provides surgical care in various specialties and among different age groups (Groen et al 2015 ; Wong et al 2015a , b ; Alvarado et al 2015 ). Even within one of the world’s major medical charitable organization, MSF, surgery has been among the least provided services.…”