Periprosthetic fractures of the proximal femur: beyond the Vancouver classification

Stoffel, Karl; Horn, Tamara; Zagra, Luigi; Mueller, Christoph; Perka, Carsten; Eckardt, Henrik

doi:10.1302/2058-5241.5.190086

Cited by 23 publications

(23 citation statements)

References 46 publications

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“…A correct differentiation between B1 and B2 fractures is essential, and it is recommended to test the stability of the stem intraoperatively before attempting to fix the fracture, especially in uncemented femoral stems. 40,41 Standard AP and lateral x-rays should be obtained to assess fracture morphology, implant stability, component malposition, bone stock, location of any osteolytic lesions, and the presence of wear. In some cases, a CT scan may be used to assess the characteristics of the fracture.…”

Section: Fracture Type Amentioning

confidence: 99%

Periprosthetic fracture management of the proximal femur

Padilla-Rojas¹,

Garín-Zertuche²,

López-Almejo³

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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Summary:The most common periprosthetic fractures occur around the hip. The most widely used classification is the Vancouver classification, and management requires careful planning and skill in both arthroplasty and fracture surgery. This article presents an overview of the diagnosis, classification, and management of periprosthetic fractures of the proximal femur. This work represents a summary review from Latin American Society Members of the International Orthopaedic Trauma Association.

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Section: Fracture Type Amentioning

confidence: 99%

Periprosthetic fracture management of the proximal femur

Padilla-Rojas¹,

Garín-Zertuche²,

López-Almejo³

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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“…CT scans can also assist in assessing the location of the fracture around the stem or box, which may have an impact on the choice of fixation device. 11 Metal artifact reduction magnetic resonance imaging can be used if implant stability is unclear from x-ray and/or CT scans but is not often accessible in resource-limited and constrained settings.…”

Section: Introductionmentioning

confidence: 99%

How resources affect management of periprosthetic fractures of the distal femur: perspectives from Israel, South Sudan, and South Africa

Bernstein

Rivkin

Weil

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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Summary:Periprosthetic fractures of the distal femur have significant morbidity in both total hip and total knee arthroplasty (THA and TKA, respectively). The incidence of these fractures is growing, with the predominant mechanism of injury being a fall from a standing height and therefore considered fragility fractures. In many countries, improved public funding and a flourishing private health care sector, when coupled with increased life expectancy, translates to more older patients receiving both TKA and THA and therefore an increased prevalence of periprosthetic fractures and their associated complications. These fractures may occur below a long stem THA, above a TKA, or between the two (so-called “interprosthetic fracture”). We will outline fracture classification, risk factors, diagnosis, and treatment options, highlighting perspectives on treating these fractures in Israel, South Africa, and South Sudan. These countries represent differing access to resources, varied comorbidity factors, and differing health care systems. The points of difference and the points of similarity will be considered.

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“…Fracture around the implant is the third most common reason for revision in the first 2 years after surgery and the second most common in the long term and can occur intraoperatively and postoperatively 7–9 . Intraoperative fractures mostly occur during insertion of the stem 10,11 . When it comes to cement free fixation of a stem the medial femoral wall plays an exceedingly important role in primary arthroplasty due to the increase in metaphyseal cementless fixed stems 12 .…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] Intraoperative fractures mostly occur during insertion of the stem. 10,11 When it comes to cement free fixation of a stem the medial femoral wall plays an exceedingly important role in primary arthroplasty due to the increase in metaphyseal cementless fixed stems. 12 The important role of the medial wall in terms of axial stability in the proximal femoral region has been demonstrated in several studies and is known to be important for the clinical outcome after fixation of proximal femoral fractures in special.…”

mentioning

confidence: 99%

Cementless femoral stem revision in total hip arthroplasty: The periprosthetic clamshell fracture. A biomechanical investigation

Kastner

Gueorguiev

Richards

et al. 2022

Journal Orthopaedic Research

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To biomechanically evaluate the stability of a diaphyseal anchored, cementless stem in presence of a proximal periprosthetic femoral medial wall defect compared to the stability of the same stem in an intact femur. Twenty-two paired human cadaveric femora were pairwise assigned either to a fracture group, featuring a proximal medial wall defect involving 40% of the stems medial anchorage distance, or a control group with native specimens. The specimens were tested under a monotonically increasing cyclic axial loading protocol. Load, cycles, and multiples of the respective body weight at implant loosening was measured. Mean initial stiffness was 2243.9 ± 467.9 N/mm for the intact group and 2190.1 ± 474.8 N/mm for the fracture group. Mean load to loosening in the intact group was 3210.5 ± 1073.2 N and 2543.6 ± 576.4 N in the fracture group, with statistical significance. Mean cycles to loosening in the intact group were 27104.9 ± 10731.7 and 20431.5 ± 5763.7 in the fracture group, with statistical significance. Mean multiples of the resulting body weight at loosening in the intact group was 548.3 ± 158.5% and 441.4 ± 104% in the fracture group, with statistical significance. A medial wall defect involving 40% of the medial anchorage distance significantly decreases the axial stability of a diaphyseal anchored stem. However, mechanical failure occurred beyond physiological stress. At loosening rates of about 4 multiples of the body weight in the fracture group, a "safe zone" remains of a 0.5-fold body weight for maximum loads and twofold body weights for average loads.

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Periprosthetic fractures of the proximal femur: beyond the Vancouver classification

Cited by 23 publications

References 46 publications

Periprosthetic fracture management of the proximal femur

Periprosthetic fracture management of the proximal femur

How resources affect management of periprosthetic fractures of the distal femur: perspectives from Israel, South Sudan, and South Africa

Cementless femoral stem revision in total hip arthroplasty: The periprosthetic clamshell fracture. A biomechanical investigation

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