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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
UPDATES ON FRACTURES 102nd CONGRESS OF THE PIEMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (S.P.L.L.O.T.) - Brescia September 9-10, 2005
NEW TECHNOLOGIES, MODERN INSTRUMENTARIUM IN ARTHROPLASTIC SURGERY
Minerva Ortopedica e Traumatologica 2005 August;56(4):355-63
Treatment of periprosthetic femur fractures
Calori G. M., D’Imporzano M., de Bellis U., Tagliabue L., Fadigati P.
III Divisione/CAD Istituto Ortopedico Gaetano Pini, Milano
Aim. With this study we analyzed available case series to evaluate the mid- and long-term surgical outcome of fractures following hip replacement and to determine whether prosthesis revision was preferable to osteosynthesis.
Methods. From January 1986 through December 1998, 91 cases of postoperative femur fracture in hip replacement patients treated at the Gaetano Pini Orthopedic Institute, Milan, were examined. Of the 91 cases, 86 (94%) underwent surgery and 55 (60%) revision of prior surgery. Of the latter, 15% had received primary, 20% secondary hip replacement, and 65% had an aseptic mobilizing prosthesis.
Results. As measured by the Harris hip rating score in relation to type of fracture, non-invasive treatment led to good outcome in only 50% of cases, whereas surgical treatment produced better results. Osteosynthesis with internal fixation (plates and screws) achieved satisfactory results in 55% of cases, whereas minimal synthesis (cerclage) led to unsatisfactory results in 67% of cases. The use of long-stem prostheses in aseptic stem mobilization achieved good outcomes, with satisfactory results reported in 80% of cases.
Conclusion. To obtain stability of the implanted prosthesis and the fracture and to ensure early patient mobilization, thus permitting restoration of the pre-operative level of quality of life, adherence to the following guidelines is recommended: 1) when fractures in a mobilizing prosthesis and scarce bone stock are present, revision with long-stem prosthesis associated or not with internal osetosynthesis should be performed; 2) when fractures in a prosthesis without signs of mobilization but with acceptable bone stock are present, internal fixation osetosynthesis should be performed, and only later should revision be carried out when needed; 3) in particularly severe cases, the prosthesis should be removed, and synthesis of bone fragments around the test stem performed in the diaphysial canal filled with autologous bone graft or morcellized homoplasty; only later should the definitive long-stem femoral component be mounted and attention directed at achieving good prosthesis fit.