Management of Type B Periprosthetic Femoral Fracture in Patients with Narrow Medullary Canal
Journal Title: Journal of Bone and Joint Diseases - Year 2018, Vol 0, Issue 0
Abstract
Background: Ce number of hip and knee replacements is increasing with beer life expectancy and so is the burden of revision surgery due to periprosthetic fractures. e incidence of intraoperative periprosthetic fractures in cementless total hip arthroplasty ranges from 1% to 20%, whereas in post-operative periprosthetic fractures, the incidence ranges between 1% and 4%. Periprosthetic fractures are associated with factors such as osteolysis, osteopenia, and aseptic loosening of the implant and usually require operative treatment. A 61-year-old man presented in emergency with a displaced fracture of neck of femur right, the patient was operated, and hemiarthroplasty was done. 3 months after surgery the patient again had a fall from height. A diagnosis of periprosthetic fracture Vancouver’s classification type B was made from the radiographs. It could not be made out whether the implant was stable or unstable hence could not be classified as B1 or B2, which was later done intraoperatively. e fracture was initially undisplaced which was later found to be displaced in serial radiographs. e recommended treatment according to Duncan and Masri for type B1 fractures is a revision with a long stem. e recommended treatment, bypass with a longer stem, was impractical in this patient due to his narrow medullary canal. Hence, open reduction internal fixation by locking compression plate and cerclage was successfully completed on the patient. e economic constraints of the patient had restricted the use of cable plate.
Authors and Affiliations
Amrit Goyal, Amitosh Mishra
Keywords
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