A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement.
Peri-prosthetic fractures (PPF) are a recognised complication following hip arthroplasty. Prosthesis design and type influence PPF pattern. Surgeons rely on classification systems, such as the Vancouver, to aid treatment planning. This study highlights a specific fracture pattern that occurs with ce...
| Main Authors: | , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
2011
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| _version_ | 1797092521842573312 |
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| author | Grammatopoulos, G Pandit, H Kambouroglou, G Deakin, M Gundle, R McLardy-Smith, P Taylor, A Murray, D |
| author_facet | Grammatopoulos, G Pandit, H Kambouroglou, G Deakin, M Gundle, R McLardy-Smith, P Taylor, A Murray, D |
| author_sort | Grammatopoulos, G |
| collection | OXFORD |
| description | Peri-prosthetic fractures (PPF) are a recognised complication following hip arthroplasty. Prosthesis design and type influence PPF pattern. Surgeons rely on classification systems, such as the Vancouver, to aid treatment planning. This study highlights a specific fracture pattern that occurs with cemented well-fixed polished, tapered, collarless (PTC) stems. We reviewed a consecutive series of 21 PPF around well fixed PTC stems. The majority of the fractures were classified pre-operatively as Vancouver B2 (14/21), but there were also B1 (6/21) and A type fractures. The B2 fractures had common radiological and intra-operative findings: a spiral fracture with extensive fragmentation of bone and cement, debonding of cement from the implant, cement fracture, and a well-fixed cement-bone interface. Reconstruction of these fractures was more difficult than suggested by the radiographs. Two of the six patients who were considered to have a Vancouver B1 fracture underwent open reduction and internal fixation (ORIF), and had treatment-related complications. Retrospective review of the radiographs showed subtle features, such as subsidence of the stem into the centraliser, that are characteristic of a B2 fracture pattern. In summary, it is important to recognise this fracture pattern around secure PTC stems in order to prevent misinterpretation of the fracture as a Vancouver B1 rather than a B2, leading to failure of treatment, and to alert the surgeon that complex reconstruction will be required because of the extensive fragmentation. |
| first_indexed | 2024-03-07T03:47:07Z |
| format | Journal article |
| id | oxford-uuid:bfdcb16b-4db7-4f8d-92dc-c4556382381c |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:47:07Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:bfdcb16b-4db7-4f8d-92dc-c4556382381c2022-03-27T05:50:38ZA unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:bfdcb16b-4db7-4f8d-92dc-c4556382381cEnglishSymplectic Elements at Oxford2011Grammatopoulos, GPandit, HKambouroglou, GDeakin, MGundle, RMcLardy-Smith, PTaylor, AMurray, DPeri-prosthetic fractures (PPF) are a recognised complication following hip arthroplasty. Prosthesis design and type influence PPF pattern. Surgeons rely on classification systems, such as the Vancouver, to aid treatment planning. This study highlights a specific fracture pattern that occurs with cemented well-fixed polished, tapered, collarless (PTC) stems. We reviewed a consecutive series of 21 PPF around well fixed PTC stems. The majority of the fractures were classified pre-operatively as Vancouver B2 (14/21), but there were also B1 (6/21) and A type fractures. The B2 fractures had common radiological and intra-operative findings: a spiral fracture with extensive fragmentation of bone and cement, debonding of cement from the implant, cement fracture, and a well-fixed cement-bone interface. Reconstruction of these fractures was more difficult than suggested by the radiographs. Two of the six patients who were considered to have a Vancouver B1 fracture underwent open reduction and internal fixation (ORIF), and had treatment-related complications. Retrospective review of the radiographs showed subtle features, such as subsidence of the stem into the centraliser, that are characteristic of a B2 fracture pattern. In summary, it is important to recognise this fracture pattern around secure PTC stems in order to prevent misinterpretation of the fracture as a Vancouver B1 rather than a B2, leading to failure of treatment, and to alert the surgeon that complex reconstruction will be required because of the extensive fragmentation. |
| spellingShingle | Grammatopoulos, G Pandit, H Kambouroglou, G Deakin, M Gundle, R McLardy-Smith, P Taylor, A Murray, D A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. |
| title | A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. |
| title_full | A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. |
| title_fullStr | A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. |
| title_full_unstemmed | A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. |
| title_short | A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement. |
| title_sort | unique peri prosthetic fracture pattern in well fixed femoral stems with polished tapered collarless design of total hip replacement |
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