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Ragland, Katelyn, Steven M. Cherney, Jeffrey B. Stambough i Simon C. Mears. "Open Periprosthetic Knee Fracture: A Case Report and Review of the Literature". Geriatric Orthopaedic Surgery & Rehabilitation 11 (1.01.2020): 215145932093954. http://dx.doi.org/10.1177/2151459320939547.
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Introduction: With the increase in knee and hip implants, these periprosthetic fractures will become more common especially as the population ages. Open periprosthetic fractures are rare and severe injuries and are more likely to be seen in high-energy injuries. They present challenges to the treating physician due to soft tissue damage, contamination of the existing implants, and the effects of polytrauma in the geriatric patient. Methods: . Results A 72-year-old woman was involved in a motor vehicle collision with multiple injuries including an open periprosthetic tibia and femur fracture. This was treated with initial washout and removal of loose tibial component with placement of a cement spacer. The knee was treated with staged revision using a protocol like that used after prosthetic joint infection. After complete soft tissue healing, the patient underwent successful revision with a megaprosthesis. The literature on open periprosthetic fractures is reviewed. Discussion and Conclusion: Open periprosthetic fractures present multiple challenges to the orthopedic surgeon. In the presences of poly trauma and soft tissue injury, we present an approach using staged surgery like that used for prosthetic joint infection.
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Paigude, Prithviraj Anil, Rahul Puranik, Shubham Nitin Katti, Saiel Kumarjuvekar, Hitarth Gathani i Rohit Jadhav. "A case of staged revision cementless Total Hip Arthroplasty following post traumatic periprosthetic Vancouver type B fracture after hemiarthroplasty". Indian Journal of Orthopaedics Surgery 8, nr 4 (15.11.2022): 302–5. http://dx.doi.org/10.18231/j.ijos.2022.056.
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The overall incidence of different types of periprosthetic fractures is on the rise constantly due to the increasing volume of primary joint arthroplasties and revision arthroplasties. Skills pertaining to advanced complex trauma and arthroplasty are necessary to manage these injuries. Inspite of various algorithms and classifications available regarding management of these injuries, it is necessary for the treating surgeon to understand that the treatment of periprosthetic fractures needs to be individualised optimal for that particular patient. We present our experience in a case of post traumatic periprosthetic Vancouver type B fracture after hemiarthroplasty treated with staged revision cementless long stem Total Hip Arthroplasty(THA).
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Mahajan, Neetin P., Kunal Chaudhari, Ravi Patel, Pramod Bagimani i Akshay Gund. "The management of complex periprosthetic femoral fractures: a case series of plating with wire augmentation, and a review of the literature". International Journal of Research in Orthopaedics 8, nr 6 (27.10.2022): 711. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20222711.
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<p class="abstract">Periprosthetic fractures continue to increase in frequency. This is due, in part, to the increasing number of primary and revision arthroplasties performed annually and to the increasing age and fragility of patients with such implants. All types of periprosthetic fractures can present unique and substantial treatment challenges. Here we present a case series of 3 elderly patients who came to us with periprosthetic hip fractures in previously operated case of hip hemiarthroplasty/total hip replacement done. The injuries were managed with splintage and operative procedures. Postoperatively mobilization was challenging. But patients were successfully mobilized with the help of relatives and physiotherapists. Periprosthetic fractures are becoming quite common in elderly and difficult to treat as the number of hip joint arthroplasty operative has increased in developing countries. the correct procedure is very challenging as every case needs to be treated very individualistically. A good plan always results in much reduction in the operating time and better patient post operative outcome. Postoperatively mobilization of patient and functional outcome is hampered. Proper counselling by operating surgeon, physiotherapy and postoperative rehabilitation with the help of relatives and assisting devices provides good outcome. So that early appropriate treatment and mobilization can be done with good functional outcome.</p>
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Borade, Amrut, Daniela Sanchez, Harish Kempegowda, Hemil Maniar, Rodrigo Pesantez, Michael Suk i Daniel Horwitz. "Minimally Invasive Plate Osteosynthesis for Periprosthetic and Interprosthetic Fractures Associated with Knee Arthroplasty: Surgical Technique and Review of Current Literature". Journal of Knee Surgery 32, nr 05 (28.03.2019): 392–402. http://dx.doi.org/10.1055/s-0039-1683443.
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AbstractWith the increasing number of total knee arthroplasties (TKAs) being performed, the incidence of periprosthetic fractures adjacent to a TKA is rising. Minimally invasive plate osteosynthesis (MIPO) has proven to be successful for the biological fixation of many fractures. Advances in surgical instrumentation and techniques made MIPO possible for more complex fractures. Periprosthetic fractures are always complicated by problems of soft tissue incisions, scarring, and, of course, the arthroplasty components. MIPO techniques may be particularly suited to these injuries and may make the surgical repair of these fractures safer and more reliable. In this review, case examples are used to define the indications, preoperative planning, implant selection, complications, limitations, and challenges of MIPO for the treatment of periprosthetic fractures about the knee. When considering MIPO for any fracture, we recommend prioritizing an acceptable reduction with biological fixation and resorting to mini-open or open approach when necessary to achieve it. Awareness of the learning curve of the surgical technique, advances in implant designs, the tips and tricks involved, and the limitations of the MIPO is of paramount importance from the orthopaedic surgeon's perspective.
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Chen, Alvin Chao-Yu, You-Hung Cheng, Chih-Hao Chiu, Chun-Ying Cheng i Yi-Sheng Chan. "Long-Term Outcomes of Radial Head Arthroplasty in Complex Elbow Fracture Dislocation". Journal of Clinical Medicine 10, nr 16 (7.08.2021): 3488. http://dx.doi.org/10.3390/jcm10163488.
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The purpose of the current study was to investigate the long-term outcomes of radial head arthroplasty in complex elbow injuries through radiographic analysis and functional correlation. We evaluated 24 radial head arthroplasties in 24 consecutive patients with complex elbow fracture dislocation. All patients were treated with a single type of modular monopolar prosthesis containing smooth stem in press-fit implantation. Clinical survey using the Mayo Elbow Performance Score (MEPS), self-reported scales of shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the visual analog scale (VAS) at more than 10-year follow-up were reported and compared to 2-year outcomes. Periprosthetic osteolysis was measured in the 10 zones of prosthesis-cortical interface with a modified radiolucency score, which was calibrated by each prosthesis size. Pearson correlation analysis was performed to detect the association between periprosthetic radiolucency and clinical assessment. At the final follow-up, MEPS, QuickDASH score and VAS score averaged 82.5 ± 15, 14.1 ± 14.3 and 1.6 ± 1.2 respectively. A decline in functional status was noted, with decreased mean MEPS and increased mean QuickDASH and VAS scores as compared to the 2-year results while the difference was insignificant. Periprosthetic osteolysis was more prevalent around stem tip of zone 3 and zone 8. The final and 2-year radiolucency scores averaged 7.4 ± 4.2 and 2.6 ± 2.3 respectively with significant difference. Pearson correlation analysis indicated that the difference between radiolucency scores and clinical outcomes in MEPS/QuickDASH/VAS was −0.836, 0.517 and 0.464. Progression of periprosthetic osteolysis after postoperative 10 years is more prevalent around the stem tip with moderate to high correlation to clinical outcomes. Sustained follow-up is warranted to justify subsequent surgery for revision or implant removal.
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Stiehl, James B. "Bacterial Autofluorescence Digital Imaging Guides Treatment in Stage 4 Pelvic Pressure Injuries: A Preliminary Case Series". Diagnostics 11, nr 5 (7.05.2021): 839. http://dx.doi.org/10.3390/diagnostics11050839.
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Pelvic pressure injuries in long-term care facilities are at high risk for undetected infection and complications from bacterial contamination and stalling of wound healing. Contemporary wound healing methods must address this problem with mechanical debridement, wound irrigation, and balanced dressings that reduce bacterial burden to enable the normal healing process. This study evaluated the impact of bacterial autofluorescence imaging to indicate wound bacterial contamination and guide treatment for severe stage 4 pelvic pressure injuries. A handheld digital imaging system was used to perform bacterial autofluorescence imaging in darkness on five elderly, high-risk, long-term care patients with advanced stage 4 pelvic pressure injuries who were being treated for significant bacterial contamination. The prescient findings of bacterial autofluorescence imaging instigated treatment strategies and enabled close monitoring of the treatment efficacy to ameliorate the bacterial contamination. Wound sepsis recurrence, adequate wound cleansing, and diagnosis of underlying periprosthetic total joint infection were confirmed with autofluorescence imaging showing regions of high bacterial load. By providing objective information at the point of care, imaging improved understanding of the bacterial infections and guided treatment strategies.
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Patsiogiannis, Nikolaos, Nikolaos K. Kanakaris i Peter V. Giannoudis. "Periprosthetic hip fractures: an update into their management and clinical outcomes". EFORT Open Reviews 6, nr 1 (styczeń 2021): 955–72. http://dx.doi.org/10.1302/2058-5241.6.200050.
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The Vancouver classification is still a useful tool of communication and stratification of periprosthetic fractures, but besides the three parameters it considers, clinicians should also assess additional factors. Combined advanced trauma and arthroplasty skills must be available in departments managing these complex injuries. Preoperative confirmation of the THA (total hip arthroplasty) stability is sometimes challenging. The most reliable method remains intraoperative assessment during surgical exploration of the hip joint. Certain B1 fractures will benefit from revision surgery, whilst some B2 fractures can be effectively managed with osteosynthesis, especially in frail patients. Less invasive osteosynthesis, balanced plate–bone constructs, composite implant solutions, together with an appropriate reduction of the limb axis, rotation and length are critical for a successful fixation and uneventful fracture healing. Cite this article: EFORT Open Rev 2021;6:955-972. DOI: 10.1302/2058-5241.6.200050
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Buchanan, James M. "Hydroxyapatite Hip Arthroplasty in Osteoporotic Bone: A Study in Female Patients Over the Age of Sixty". Key Engineering Materials 309-311 (maj 2006): 1345–48. http://dx.doi.org/10.4028/www.scientific.net/kem.309-311.1345.
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Uncemented hip arthroplasty is gaining interest. However, it is alleged that uncemented hip implants fail in osteoporotic bone because of early loosening and a higher incidence of periprosthetic fractures. Will Hydroxyapatite Ceramic Coated Hips (HAC) bond on to the osteoporotic bone and continue to function well in this vulnerable group of patients? Post-menopausal women are prone to develop osteoporosis. They are seen too frequently with wrist, hip and spinal crush fractures following minor low impact injuries. These ladies also contribute to the cohort of patents requiring hip arthroplasty for all the usual diagnoses including sub capital fractures. This is a study of HAC hip arthroplasty in female patients over the age of sixty which includes women with osteoporosis.
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Ingoe, Helen M., Philip Holland, Paul Cowling, Lucksy Kottam, Paul N. Baker i Amar Rangan. "Intraoperative complications during revision shoulder arthroplasty: a study using the National Joint Registry dataset". Shoulder & Elbow 9, nr 2 (4.01.2017): 92–99. http://dx.doi.org/10.1177/1758573216685706.
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Background The surgical options for revision shoulder arthroplasty and the number of procedures performed are increasing. However, little is known about the risk factors for intraoperative complications associated with this complex surgery. Methods The National Joint Registry (NJR) is a surgeon reported database recording information on major joint replacements including revision shoulder arthroplasty. Using multivariable binary logistic regression modelling, we analyzed 1445 revision shoulder arthroplasties reported to the NJR between April 2012 and 2015. Results The risk of developing a complication during revision surgery was greater than primary arthroplasty (5% versus 2.5%). An intraoperative fracture was the most common complication occurring in 50 (3.5%) cases. Nerve injuries were recorded for two (0.1%) patients and vascular injuries for one (0.1%) patient. The incidence of intraoperative fractures was higher in females than males (relative risk = 3.25; p = 0.005). Periprosthetic fracture as an indication for revision carried the highest risk for any complication (relative risk = 3.00, p = 0.06). Conclusions This is the largest registry study to date investigating the incidence and risk factors for intraoperative complications during revision shoulder arthroplasty. Females have over three times the risk of intraoperative fractures compared to males. This study will help inform surgeons to accurately counsel patients.
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Kamineni, Srinath, R. Zackary Unger i Rasesh Desai. "Shoulder Arthrodesis in the Management of Glenohumeral Pathologies". Journal of Shoulder and Elbow Arthroplasty 3 (styczeń 2019): 247154921985065. http://dx.doi.org/10.1177/2471549219850655.
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Background In an era of advanced shoulder stabilization procedures, arthroplasty implants and techniques, shoulder arthrodesis is considered an end-stage salvage procedure with negative connotations. However, in correctly selected patients, arthrodesis can alleviate pain, provide acceptable and stable motion, with a resultant functional shoulder. Methods The current literature on shoulder arthrodesis was reviewed to determine the indications, surgical technique, post-operative rehabilitation, complications and outcomes. Results Indications for shoulder arthrodesis include brachial plexus injuries, paralytic disorders, pseudo paralysis from combined severe/irreparable rotator cuff and deltoid injuries, inflammatory arthritis with severe rotator cuff pathology, persistent refractory instability, and tumor resection. Shoulder arthrodesis generally involves compression screws with or without plate fixation and bone graft. The arthrodesis is positioned to optimize the function of the extremity, primarily for activities of daily living. Postoperatively, most patients are immobilized for 8 to 10 weeks, dependent on the completeness of radiological fusion. Complications include nonunion, shoulder girdle muscle atrophy, painful hardware, periprosthetic fractures, and infection. Discussion With the use of recent biological innovations, the nonunion rate has declined, and rehabilitation technologies have allowed maintenance of muscle mass for future conversion to shoulder arthroplasty. Hence, in carefully selected patients, shoulder arthrodesis provides a valuable option for a stable, functional, and pain-free shoulder and should be retained as part of the treatment algorithm for complex shoulder pathology.
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Nasser, Ahmed A. H. H., Khabab Osman, Govind S. Chauhan, Rohan Prakash, Charles Handford, Rajpal S. Nandra i Ansar Mahmood. "Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip". Bone & Joint Open 4, nr 9 (1.09.2023): 659–67. http://dx.doi.org/10.1302/2633-1462.49.bjo-2023-0065.r1.
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AimsPeriprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade.MethodsUsing a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade.ResultsA total of 1,104 patients were included. The majority were female (57.9%; n = 639), ethnically white (88.5%; n = 977), used mobility aids (67%; n = 743), and had a median age of 82 years (interquartile range (IQR) 74 to 87). A total of 77 (7%) had pain prior to the PPF. The most common UCS grade was B2 (33%; n = 368). UCS type D fractures had the longest length of stay (median 19 days (IQR 11 to 26)), highest readmission to hospital (21%; n = 9), and highest rate of discharge to step-down care (52%; n = 23). Multinomial regression suggests that uncemented femoral stems are associated with a reduced risk of UCS C (RRR 0.36 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002) and increased risk of UCS A (RRR 3.3 (95% CI 1.9 to 5.7); p < 0.001), compared to UCS B fracture.ConclusionThe most common PPF type in elderly frail patients is UCS B2. Uncemented stems have a lower risk of UCS C fractures compared to cemented stems. A national PPF database is needed to further identify correlation between implants and fracture subtypes.Cite this article: Bone Jt Open 2023;4(9):659–667.
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Oliver, William M., Henry K. C. Searle, Zhan Herr Ng, Neil R. L. Wickramasinghe, Samuel G. Molyneux, Tim O. White, Nicholas D. Clement i Andrew D. Duckworth. "Fractures of the proximal- and middle-thirds of the humeral shaft should be considered as fragility fractures". Bone & Joint Journal 102-B, nr 11 (1.11.2020): 1475–83. http://dx.doi.org/10.1302/0301-620x.102b11.bjj-2020-0993.r1.
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Aims The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis. Methods Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed. Results A total of 900 fractures (typical 88.9%, n = 800/900; pathological 8.3%, n = 75/900; periprosthetic 2.8%, n = 25/900) were identified in 898 patients (mean age 57 years (16 to 97), 55.5% (n = 498/898) female). Overall fracture incidence was 12.6/100,000/year. For patients with a typical fracture (n = 798, mean age 56 years (16 to 96), 55.1% (n = 440/798) female), there was a bimodal distribution in men and unimodal distribution in older women (Type G). A fall from standing was the most common injury mechanism (72.6%, n = 581/800). The majority of fractures involved the middle-third of the diaphysis (47.6%, n = 381/800) followed by the proximal- (30.5%, n = 244/800) and distal-thirds (n = 175/800, 21.9%). In all, 18 injuries (2.3%) were open and a radial nerve palsy occurred in 6.7% (n = 53/795). Fractures involving the proximal- and middle-thirds were more likely to occur in older (p < 0.001), female patients (p < 0.001) with comorbidities (p < 0.001) after a fall from standing (p < 0.001). Proximal-third fractures were also more likely to occur in patients with alcohol excess (p = 0.003) and to be classified as AO-Orthopaedic Trauma Association type B or C injuries (p < 0.001). Conclusion This study updates the incidence and epidemiology of humeral diaphyseal fractures. Important differences in patient and injury characteristics were observed based upon fracture location. Injuries involving the proximal- and middle-thirds of the humeral diaphysis should be considered as fragility fractures. Cite this article: Bone Joint J 2020;102-B(11):1475–1483.
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Khan, Sameer K., Ben Tyas, Amy Shenfine, Simon S. Jameson, Dominic S. Inman, Scott D. Muller i Mike R. Reed. "Reoperation and revision rates at ten years after 1,312 cemented Thompson’s hemiarthroplasties". Bone & Joint Open 3, nr 9 (1.09.2022): 710–15. http://dx.doi.org/10.1302/2633-1462.39.bjo-2022-0084.
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Aims Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes. Methods Patient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries. Results In total, 1,312 Thompson’s hemiarthroplasties were analyzed (mean age at surgery 82.8 years); 125 complications were recorded, necessitating 82 returns to theatre. These included 14 patients undergoing aspiration or manipulation under anaesthesia, 68 reoperations (5.2%) for debridement and implant retention (n = 12), haematoma evacuation (n = 2), open reduction for dislocation (n = 1), fixation of periprosthetic fracture (n = 5), and 48 revised stems (3.7%), for infection (n = 13), dislocation (n = 12), aseptic loosening (n = 9), persistent pain (n = 6), periprosthetic fracture (n = 4), acetabular erosion (n = 3), and metastatic bone disease (n = 1). Their status at ten years is summarized as follows: 1,180 (89.9%) dead without revision, 34 (2.6%) dead having had revision, 84 (6.6%) alive with the stem unrevised, and 14 (1.1%) alive having had revision. Cumulative implant survivorship was 90.3% at ten years; patient survivorship was 7.4%. Conclusion The Thompson’s stem demonstrates very low rates of complications requiring reoperation and revision, up to ten years after the index procedure. Fewer than one in ten patients live for ten years after fracture. This study supports the use of a cemented Thompson’s implant as a cost-effective option for frail hip fracture patients. Cite this article: Bone Jt Open 2022;3(9):710–715.
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Ayekoloye, Charles I., Moayad Abu Qa'oud, Mehran Radi, Sebastian A. Leon, Paul Kuzyk, Oleg Safir i Allan E. Gross. "Review of complications, functional outcome, and long-term survival following conversion of hip fusion to total hip arthroplasty". Bone & Joint Journal 103-B, nr 7 Supple B (1.07.2021): 129–34. http://dx.doi.org/10.1302/0301-620x.103b7.bjj-2020-2382.r1.
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Aims Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. Methods A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and heterotopic ossification (HO). Postoperative complications and implant survival were assessed. Results At mean 12.2 years (2 to 24) follow-up, HHS improved from mean 34.2 (20.8 to 60.5) to 75 (53.6 to 94.0; p < 0.001). Mean postoperative ROM was flexion 77° (50° to 95°), abduction 30° (10° to 40°), adduction 20° (5° to 25°), internal rotation 18° (2° to 30°), and external rotation 17° (5° to 30°). LLD improved from mean -3.36 cm (0 to 8) to postoperative mean -1.14 cm (0 to 4; p < 0.001). Postoperatively, 26 patients (68.4%) required the use of a walking aid. Complications included one (2.5%) dislocation, two (5.1%) partial sciatic nerve injuries, one (2.5%) deep periprosthetic joint infection, two instances of (5.1%) acetabular component aseptic loosening, two (5.1%) periprosthetic fractures, and ten instances of HO (40%), of which three (7.7%) were functionally limiting and required excision. Kaplan-Meier Survival was 97.1% (95% confidence interval (CI) 91.4% to 100%) at ten years and 88.2% (95% CI 70.96 to 100) at 15 years with implant revision for aseptic loosening as endpoint and 81.7% (95% CI 70.9% to 98.0%) at ten years and 74.2% (95% CI 55.6 to 92.8) at 15 years follow-up with implant revision for all cause failure as endpoint. Conclusion The use of an optimal and consistent surgical technique and cementless implants can result in significant functional improvement, low complication rates, long-term implant survival, and high patient satisfaction following conversion of hip fusion to THA. The possibility of requiring a walking aid should be discussed with the patient before surgery. Cite this article: Bone Joint J 2021;103-B(7 Supple B):129–134.
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Boyarov, A. A., A. V. Ambrosenkov, A. G. Aliev, R. M. Tikhilov i I. I. Shubnyakov. "Risk factors for infectious complications after total elbow arthroplasty". Grekov's Bulletin of Surgery 181, nr 1 (28.12.2021): 88–93. http://dx.doi.org/10.24884/0042-4625-2022-181-1-88-93.
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INTRODUCTION. Total elbow arthroplasty (TEA) is a good alternative surgical solution for many patients with severe traumatic and inflammatory joint injuries. However, this surgical procedure is characterized by a rather high incidence of periprosthetic joint infection (PJI): from 3 to 8 %. At present, the issue of the influence of various factors on the risk of PJI is relevant.The OBJECTIVE of the study was to identify risk factors for the development of PJI after primary TEA.METHODS AND MATERIALS. In a retrospective study, the data of 485 patients who underwent primary and revision TEA from 2003 to 2019 were analyzed. The total number of studied patients was divided into 2 groups. The main group consisted of 51 patients who underwent revision TEA for PJI. The control group included 434 patients who underwent primary TEA.RESULTS. Evaluation of the effect of the primary diagnosis on the risk of PJI development showed a statistically significant relationship only in patients with gunshot wounds of the elbow joint (p=0.01). In the study of possible anamnestic factors, the following were significant: a history of previous interventions on elbow joint (p=0.004), previous infection (p <0.001) and open fracture of the elbow (p=0.009).CONCLUSION. In the course of the study, we proved the influence of anamnestic factors in the occurrence of PJI. Performing a two-stage revision allows stopping the infectious process with high efficiency in most cases.
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Schreiner, Anna, Christoph Gonser, Christoph Ihle, Max Zauleck, Tim Klopfer, Fabian Stuby, Ulrich Stöckle i Björn Ochs. "Adverse Events in the Treatment of Periprosthetic Fractures Around the Knee – a Clinical and Radiological Outcome Analysis". Zeitschrift für Orthopädie und Unfallchirurgie 156, nr 03 (17.01.2018): 287–97. http://dx.doi.org/10.1055/s-0043-123831.
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Abstract Background The incidence of periprosthetic fractures associated with total knee arthroplasty (PpFxK) has been reported to be 0.3 – 5.5%. 40% of all cases are related to revision TKA. The most common localisation is the distal femur. Classification is performed according to Rorabeck (RB). RB I – II fractures are usually treated with locked plating and retrograde intramedullary nailing, whereas RB III fractures are an indication for revision arthroplasty using a hinged endoprosthesis. PpFxK of the patella can be classified according to Goldberg and PpFxK of the proximal tibia can be grouped as in Felix. Interprosthetic fractures can be regarded as a special type of PpFx. Due to the increasing numbers of TKA being performed, increasing numbers of adverse events in arthroplasty can be expected. Adverse events in the treatment of PpFxK occur in up to 41% of patients according to the literature and revision is needed in approximately 29% of all cases. Risk factors are age, osteoporosis, infection, malalignment, osteolysis/loosening of the implant and status post revision. Patients A clinical and radiographic follow-up was performed with 50 patients (14 men, 36 women) treated for PpFxK of the femur, tibia and patella between 2011 and 2015 at the department of arthroplasty at a level 1 trauma center in Europe. Results The follow-up of all patients was 68%, with an average of 19.1 ± 14.6 (1 – 49) months between PpFxK and clinical follow-up. 16% of the patients were allocated for further treatment or revision surgery from other hospitals. The patientsʼ median age was 78.0 ± 8.8 (55 – 94) years. Most patients were affected by several orthopaedic and internal medical comorbidities. PpFxK classified as RB II were the most common fractures (60%, n = 30). PpFxK usually occurred 5.0 ± 4.8 (0 – 20) years after index TKA (primary or revision TKA), mostly in patients with CR-retaining endoprosthesis, whereas PpFxK according to Felix occurred significantly earlier and mostly in hinged TKAs. Patients achieved on average a mean Oxford Knee Score of 31.1 ± 9.9 (14 – 46) points. The functional Knee Society Score (KSS) was 52.6 ± 24.4 (20 – 100) and the mean KSS was 58.7 ± 26.8 (0 – 99) points (n = 25). Radiographic evaluation of the RB I – II patients showed frontal and sagittal malalignment in 20.6% of all cases after reduction and plate fixation. The overall rate of surgical adverse events was 50%; 44% of all RB patients needed revision surgery. Adverse events comprised non-union, failure of osteosynthesis, infection, wound healing disorders and re-fractures in the RB II and the Felix subgroup. Conclusion PpFxK are severe injuries and are associated with a high rate of adverse events related to treatment. Patients often have a complex background and a history of revision surgery or periprosthetic joint infection. The treatment of PpFxK should therefore take place at a centre with expertise in traumatology as well as in revision arthroplasty. Preoperative infection diagnostic testing as well as adequate imaging (X-rays and CT) are essential. We furthermore advise early evaluation of revision arthroplasty, especially in elderly patients suffering from PpFxK with insufficient bone quality around the TKA and closeness between fracture and TKA. In the case of plate fixation, it is important to give attention to correct reduction – to prevent non-union, loosening of the implant and failure of the osteosynthesis – as well as to consider double plating.
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Khan, Akib Majed, Quen Oat Tang i Dominic Spicer. "The Epidemiology of Adult Distal Femoral Shaft Fractures in a Central London Major Trauma Centre Over Five Years". Open Orthopaedics Journal 11, nr 1 (13.11.2017): 1277–91. http://dx.doi.org/10.2174/1874325001711011277.
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Background:Distal femoral fractures account for 3-6% of adult femoral fractures and 0.4% of all fractures and are associated with significant morbidity and mortality rates. As countries develop inter-hospital trauma networks and adapt healthcare policy for an aging population there is growing importance for research within this field.Methods:Hospital coding and registry records at the central London Major Trauma Center identified 219 patients with distal femoral shaft fractures that occurred between December 2010 and January 2016. CT-Scans were reviewed resulting in exclusion of 73 inappropriately coded, 10 pediatric and 12 periprosthetic cases. Demographics, mechanism of injury, AO/OTA fracture classification and management were analyzed for the remaining 124 patients with 125 fractures. Mann Whitney U and Chi Squared tests were used during analyses.Results:The cases show bimodal distribution with younger patients being male (median age 65.6) compared to female (median age 71). Injury caused through high-energy mechanisms were more common in men (70.5%) whilst women sustained injuries mainly from low-energy mechanisms (82.7%) (p<0.0001). Majority of fractures were 33-A (52.0%) followed by 33-B (30.4%) and 33-C (17.6%). Ninety-two (73.6%) underwent operative management. The most common operation was locking plates (64.1%) followed by intramedullary nailing (19.6%).Interpretation:The epidemiology of a rare fracture pattern with variable degrees of complexity is described. A significant correlation between biological sex and mechanism of injury was identified. The fixation technique favored was multidirectional locking plates. Technical requirements for fixation and low prevalence of 33-C fractures warrant consideration of locating treatment at centers with high caseloads and experience.
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Harper, Katharine D., Paul Navo, Frederick Ramsey, Sainabou Jallow i Saqib Rehman. "“Hidden” Preoperative Blood Loss With Extracapsular Versus Intracapsular Hip Fractures: What Is the Difference?" Geriatric Orthopaedic Surgery & Rehabilitation 8, nr 4 (22.11.2017): 202–7. http://dx.doi.org/10.1177/2151458517729615.
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Purpose: Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures. Methods: 472 patients were evaluated over a five-year period. Those who presented to the hospital with a proximal femur fracture (femoral neck, IT or ST) were considered for the study. Exclusion criteria included polytrauma, gunshot injuries, periprosthetic fractures, and non-operative management. Primary endpoint was hemoglobin (Hgb) drop from admission to day of surgery (DOS); secondary endpoint was need for pre-op transfusion and discharge location. Results: 304 patients were analyzed who sustained a proximal femur fracture. Median IC Hgb drop was 0.6g/dL; median EC Hgb drop was 1.1g/dL from admission to DOS ( p = 0.0272). Rate of pre-operative transfusions was higher in EC (36/194 = 18.6%) than IC fractures (5/105 = 4.5%) ( p = 0.0006), and overall transfusion rates remained higher throughout hospital stay (55.7% EC vs. 32.7% IC; p = 0.0001). Breakdown of bleeding rate and tranfusion rates between IT and ST fractures were not significant ( p = 0.07; p = 0.4483). Extracapsular hip fractures were more likely to be discharged to a skilled nursing facility (SNF) (84.4% EC vs. 73.8% IC; p = 0.027). Conclusion: Intracapsular hip fractures have significantly less pre-operative blood loss and fewer pre-operative transfusions than their extracapsular counterparts. These findings can be used to establish appropriate pre-operative resuscitative efforts, ensuring that hip fracture protocols account for the increased likelihood of blood loss in extracapsular fractures.
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DAVUT, Serkan, Hasan HALLAÇELİ i İrem HÜZMELİ. "Investigation of long-term fall prevalence after total knee arthroplasty in Hatay: A cross-sectional study". Journal of Experimental and Clinical Medicine 39, nr 3 (30.08.2022): 654–59. http://dx.doi.org/10.52142/omujecm.39.3.12.
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Falls and fractures caused by falls in the elderly affect their daily activities, creating fear of movement and alienating the individual from social participation. Fall related-injuries are some of the main afraid complications after total knee arthroplasty surgery. The aim of this study is to determine the incidence of falling and fear of movement in the long period (one year and more after surgery) in patients who had total knee arthroplasty surgery. Patients who had total knee arthroplasty surgery in Hatay Mustafa Kemal University Department of Orthopedics and Traumatology between 01.01.2016 and 01.10.2020 enrolled in the study. Demographic information was recorded from the patient file or asked to the patients/caregivers via telemedicine. The falls before the surgery, falls after the surgery within 3 months, within 3 to 6 months, within 6 to 12 months which caregiver/relative’s remember recorded via telemedicine. Fear of movement assessed with the Tampa Kinesiophobia Scale was asked. 149 Patients with, mean age 67.06±8.72 years, female (85.9%), mostly house wives (80.5%) was the cohort. Their education time (89.8 %) were less than 5 years, and the huge majority of the patients did not have exercise habits (83.2%). The fall rate before the surgery was (35.6%), after the surgery was (36.9%), within the first 3 months (6.7%), 3 to 6 months (6%) and 6 to 12 months (11.7%). 7. 4 % of our patients had a fall related-fractures including: 2 radius distal fractures (1.3%), 3 hip fractures (2%), 3 periprosthetic fractures (2%), 1 patella fracture (0. 7%) and 2 vertebral compression fractures (1.3%). Tampa Kinesiophobia Scale score was 41(38-44). There was a positive correlation between kinesiofobia and those who did not have exercise habits and those who fell preoperatively (r: 0.31, p:0.01). Some of TKA patients were falling and had fear of movement. New researches should be conducted about what is the reason that makes the patients posture and movement more stable or which mechanism alters the balance. In order to prevent complications that may occur due to falls, new studies, treatment modalities and rehabilitation programs focusing on the etiology of falling in the elderly individuals should be organized.
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Matsumiya, Yutaka, Keisuke Oe, Tomoaki Fukui, Teruya Kawamoto, Ryosuke Kuroda i Takahiro Niikura. "A Case of Nonunion with Ballooning Deformity after Periprosthetic Humeral Fracture". Journal of Orthopaedic Case Reports 12, nr 1 (2022): 89–91. http://dx.doi.org/10.13107/jocr.2022.v12.i01.2632.
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Introduction:We report a very rare case of nonunion with ballooning deformity of the humeral bone after a periprosthetic humeral fracture nonunion. Case Report: A 79-year-old woman underwent hemiarthroplasty 19 years ago for her proximal humerus fracture. She injured her right humeral diaphysis (stem distal end fracture) 6 years ago. She underwent revision hemiarthroplasty with long stem, but bony union was not obtained, and her right upper limb function was subsequently abolished due to extreme instability and pain in her right upper arm. She was then referred to our hospital for further treatment. X-ray showed nonunion in the humeral diaphysis and a severe ballooning deformity in the distal humeral bone fragment. Due to the advanced age and low activity of the patient, we chose total humerus replacement surgery instead of osteosynthesis. After the surgery, her upper arm pain and instability immediately improved. Three years after the last surgery, there have been no implant failures, and the upper arm is stable and painless. Conclusion:Although there are some reports of total humerus replacement as surgical treatment for humeral tumor and severe periprosthetic fracture, we found no reports of such ballooning deformity around the nonunion site. Total humerus replacement can be one of the treatment options in cases where nonunion surgery is extremely difficult, depending on the patient’s age and activities of daily living. Keywords:Ballooning deformity, nonunion, periprosthetic fracture, total humeral replacement.
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Vallier, Heather A. "Continuous improvement in optimizing the timing of axial, hip, and femoral fracture fixation". Bone & Joint Journal 105-B, nr 4 (15.03.2023): 361–64. http://dx.doi.org/10.1302/0301-620x.105b4.bjj-2022-1025.r1.
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Benefits of early stabilization of femoral shaft fractures, in mitigation of pulmonary and other complications, have been recognized over the past decades. Investigation into the appropriate level of resuscitation, and other measures of readiness for definitive fixation, versus a damage control strategy have been ongoing. These principles are now being applied to fractures of the thoracolumbar spine, pelvis, and acetabulum. Systems of trauma care are evolving to encompass attention to expeditious and safe management of not only multiply injured patients with these major fractures, but also definitive care for hip and periprosthetic fractures, which pose a similar burden of patient recumbency until stabilized. Future directions regarding refinement of patient resuscitation, assessment, and treatment are anticipated, as is the potential for data sharing and registries in enhancing trauma system functionality.Cite this article: Bone Joint J 2023;105-B(4):361–364.
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Bhat, Towseef Ahmad, Zameer Ali i Manik Sehgal. "Short term results of modular bipolar hemiarthroplasty for the treatment of neglected trochanteric femur fracture in the elderly". International Journal of Research in Orthopaedics 6, nr 1 (24.12.2019): 53. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20195620.
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<p class="abstract"><strong>Background:</strong> In rural India because of native practitioner culture people tend to neglect orthopaedic injuries and often present late to the hospitals. Bipolar hemiarthroplasty for neglected intertrochanteric fractures of the femur in the elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.</p><p class="abstract"><strong>Methods:</strong> Sixteen patients with proximal extracapsular femoral fractures presented average 10.4 weeks late from the day of injury, were treated with modular bipolar hemiarthroplasty. There were 11 men and 5 women, with mean age of 72.8 years (range: 65–83 years). Primary cemented bipolar hemiarthroplasty was performed using the Hardinge lateral approach in a lateral decubitus position. Harris hip score was used for the clinical evaluation of the patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> Clinically, the Harris hip score at the last follow-up ranged from 92 to 59, with a mean value of 81.7. Postoperative radiographs showed a good position in all patients. 1 patient developed complication during cementing and 1 case came with dislocation. No case of infection, acetabular erosion, periprostheic fracture or implant loosening was reported in this study.</p><p class="abstract"><strong>Conclusions:</strong> Primary cemented bipolar hemiarthroplasty is a good choice in elderly patients with neglected intertrochanteric fractures of the femur.</p>
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Tomar, Lavindra, Gaurav Govil i Pawan Dhawan. "Bilateral Periprosthetic Knee Fracture with the Right Floating Total Knee and Left Periprosthetic Patella Fracture Management Strategy: A Case Report". JOURNAL OF ORTHOPAEDIC CASE REPORTS 11, nr 1 (11.01.2021). http://dx.doi.org/10.13107/jocr.2021.v11.i02.2000.
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Introduction: Periprosthetic fractures (PPFs) in total knee replacement are an uncommon condition. The floating knee injury around total knee arthroplasty (TKA) is even rare and poses challenges in management. Incidence is increasing due to growing primary joint arthroplasties and revision procedures. We report a case of bilateral PPF with a floating total knee. Case Report: A 74-year-old female involved in a violent car accident sustained bilateral knee injuries, facial, and hand injury. In the emergency room, the initial resuscitation and trauma protocol stabilization were done and she was provisionally immobilized for her limb injuries. She presented with the right-sided floating total knee involving periprosthetic periarticular comminuted distal femur fracture and midshaft comminuted fracture tibia fibula. The patient also had left knee lower pole periprosthetic patellar fracture. The patient had a history of bilateral TKA around 2 years back. She underwent surgical management of the right floating total knee by stabilization of distal femur fracture and tibial shaft fracture fixation with locking plates. She underwent primary autologous bone grafting for both fracture sites. The left knee patellar fracture was managed conservatively in a brace. At 8 months follow-up, the patient was pain free and had consolidation of fractures. The patient walked without any walking aids. At 18 months, she had regained her pre-injury functional status. Conclusion: Each fracture in a floating total knee injury is unique and treatment should be decided based on individual analysis and the extent of soft-tissue injuries. An uncommon occurrence highlights the complex injury patterns involving PPF requiring individualized case specific management strategy. Keywords: Floating total knee, Periprosthetic knee fracture, floating knee.
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Kaufman, Matthew W., Alexander S. Rascoe, Jeffrey L. Hii, Mitchell L. Thom, Ari D. Levine, Roger G. Wilber, Adam G. Hirschfeld, Nicholas M. Romeo i Glenn D. Wera. "Comparable Outcomes Between Native and Periprosthetic Fractures of the Distal Femur". Journal of Knee Surgery, 12.07.2022. http://dx.doi.org/10.1055/s-0042-1749604.
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AbstractDespite the rising prevalence of arthroplasty and aging population, limited data exist regarding differences in periprosthetic fracture clinical outcomes compared with native counterparts. This study compares differences in hospital treatment, morbidity, and mortality associated with periprosthetic distal femur fractures at an urban level 1 trauma center. We retrospectively reviewed all adult AO/OTA type 33 fractures (526) that presented to our institution between 2009 and 2018. In total, 54 native and 54 periprosthetic fractures were matched by age and gender. We recorded demographics, operative measures, length of stay (LOS), discharge disposition, and mortality. We used McNemar's and paired t-tests for analysis where appropriate (p < 0.05) (IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY; IBM Corp.). The average age at injury was 74 years ± 12 (native) compared with 73 years ± 12 (periprosthetic). After 1:1 matching, the groups had similar body mass index (31.01 vs. 32.98, p = 0.966 for native and periprosthetic, respectively) and mechanisms of injury with 38 native and 44 periprosthetic (p = 0.198) fractures from low-energy falls. Both groups had 51/54 fractures managed with open reduction internal fixation with a locking plate. The remaining were managed via amputation or intramedullary nail fixation. Mean operative time (144 minutes (±64) vs. 132 minutes (±62), p = 0.96) and estimated blood loss (319 mL (±362) vs. 289 mL (±231), p = 0.44) were comparable between the native and periprosthetic groups, respectively. LOS: 9 days ± 7 (native) versus 7 days ± 5 (periprosthetic, p = 0.31); discharge disposition (to skilled nursing facility/rehab): n = 47 (native) versus n = 43 (periprosthetic, p = 0.61); and mortality: n = 6 (native) versus n = 8 (periprosthetic, p = 0.55). No significant differences were observed. We found no statistical differences in morbidity and mortality in periprosthetic distal femur fractures treated over 10 years at a level 1 trauma center. Native and periprosthetic AO/OTA type 33 distal femur fractures are serious injuries with similar outcomes at a level 1 trauma center.
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"Research". Bone & Joint 360 12, nr 2 (1.04.2023): 42–44. http://dx.doi.org/10.1302/2048-0105.122.360043.
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The April 2023 Research Roundup360 looks at: Ear protection for orthopaedic surgeons?; Has arthroscopic meniscectomy use changed in response to the evidence?; Time to positivity of cultures obtained for periprosthetic joint infection; Bisphosphonates for post-COVID-19 osteonecrosis of the femoral head; Missing missed fractures: is AI the answer?; Congenital insensitivity to pain and correction of the knee; YouTube and paediatric elbow injuries.
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Zhang, Qingyu, Fuqiang Gao, Wei Sun i Zirong Li. "Bilateral multiple periprosthetic hip fractures and joint dislocations secondary to general convulsive seizures". BMC Musculoskeletal Disorders 22, nr 1 (9.08.2021). http://dx.doi.org/10.1186/s12891-021-04557-2.
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Abstract Background During a seizure, there is a powerful and forceful contraction of muscles which may lead to fractures or joint dislocations. However, multiple periprosthetic hip fractures and joint dislocations secondary to seizures have not been reported. Case presentation A 49-year-old male developed spontaneous and bilateral multiple periprosthetic hip fractures and joint dislocations (including displaced fracture of the proximal right femur, avulsion fracture of the left lesser trochanter, left acetabular fracture and bilateral joint dislocations) secondary to generalized convulsive seizures which occurred within few hours after bilateral total hip arthroplasties (THAs). Bilateral open reconstruction and fixation were performed on the 21st day after primary THAs and on 2-year follow-up, the patient showed satisfactory functional outcome. Conclusions Multiple periprosthetic hip fractures and joint dislocations secondary to seizure are extremely rare, and treatment targets for these injuries should focus on fracture healing and limb function recovery. Craniocerebral operation could bring an elevated risk of seizure; meanwhile, subsequent corticosteroid replacement threapy was complicated by secondary osteoporosis. Therefore, anti-osteoporotic and anti-epileptic therapy should be considered in this type of patients to avoid fracture and dislocation after arthroplasty.
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Pellegrino, Achille, Andrea Coscione, Adriano Santulli, Giuseppe Pellegrino i Mario Paracuollo. "KNEE PERIPROSTHETIC FRACTURES IN THE ELDERLY: CURRENT CONCEPT". Orthopedic Reviews 14, nr 6 (13.10.2022). http://dx.doi.org/10.52965/001c.38566.
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Periprosthetic fractures around total knee arthroplasty in elderly represent an emerging cause of implant revision and their incidence seems destined to further increase in the upcoming years, considering the ever-increasing number of implanted prostheses. These are complex injuries with very high complication rates. It has been estimated that the incidence of femoral periprosthetic fractures after T.K.A. ranged between 0,3 to 2,5%, but increases up to 38% when considering revision T.K.A. Patient-related risk factors for T.K.A. periprosthetic fracture (T.K.A.P.F.) include osteoporosis, age, female sex, revision arthroplasty and peri-implant osteolysis. The grate debate concerns the choice of the most appropriate fixation device for T.K.A.P.F.: closed or open reduction with internal fixation with either locked plate or intramedullary nail is the most commonly used for treating these fractures. Success of these methods depends on the fracture pattern, the stability of implants, and the patient’s bone quality which is often poor in elderly, thus resulting in high complication rates. Conversely, a revision of T.K.A. (R.T.K.A.) should be considered in case of prosthetic component instability, severe comminution or metaphyseal extension of the fracture (that precludes a good fixation), previous treatments failure and severe malalignment of T.K.A. Instead megaprosthesis and allograft-prosthesis composite are necessary in case of sever bone loss. Considering the variability of the clinical scenario of T.K.A.P.F., this complex injury requires and experienced and comprehensive approach based on both facture fixation and/or revision arthroplasty.
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Samra, Inderpaul, Tariq A. Kwaees, Wael Mati, Clare Blundell, Suzanne Lane, John W. K. Harrison i Charalambos P. Charalambous. "Anatomic Monopolar Press-fit Radial Head Arthroplasty; High Rate of Loosening at Mid-Term Follow Up". Shoulder & Elbow, 2.03.2022, 175857322210807. http://dx.doi.org/10.1177/17585732221080768.
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Introduction Radial head arthroplasty (RHA) is used for the management of unstable or unreconstructable injuries of the radial head. Our aim was to investigate clinical and radiographic outcomes in patients treated with the Acumed anatomic radial head press-fit system for trauma. Methods Clinical and radiographic assessment of RHAs undertaken for trauma with minimum 2-year follow-up. Results 16 consecutive patients, mean age 53 (21–82) and 66 month ± 27 (26–122) clinical follow-up were included. There were marked radiographic changes with 11/16 showing periprosthetic lucent lines and 13/16 showing subcollar osteolysis. Radiographic changes occurred early post-surgery. Stem loosening was associated with larger cantilever quotients (0.47 vs 0.38, p = 0.004). Overall survivability was 81.2%, with 3 RHAs removed. Clinical outcomes for the retained RHAs were acceptable with mean flexion 134°, extension deficit of 10°, pronation of 82°, and supination of 73°. Mean VAS scores were 8.5 ± 14.4, QuickDASH 13.8 ± 18.9, Mayo Elbow Performance Scores were 91.5 ± 12.5 with no poor scores. Conclusion Mid-term clinical functional outcomes following the Acumed anatomic RHA are acceptable in most cases. However, in view of the extensive periprosthetic lucencies and surgical removal due to loosening, patients should be cautioned when consented for implantation of the prosthesis, especially if a large collar is anticipated.
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Hannon, Charles P., i Matthew P. Abdel. "Revision Total Hip Arthroplasty with a Modular Fluted Tapered Stem for a Periprosthetic Femoral Fracture". JBJS Essential Surgical Techniques 13, nr 3 (2023). http://dx.doi.org/10.2106/jbjs.st.22.00023.
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Background: As the number of primary total hip arthroplasty procedures performed each year continues to rise, so too do the number of complications, including periprosthetic femoral fracture 1–9 . Vancouver B2 and B3 periprosthetic femoral fractures are difficult to treat because they require the surgeon to simultaneously manage a femoral fracture and gain new implant fixation. Fluted tapered stems have advanced the treatment of periprosthetic femoral fractures by providing immediate axial and rotational implant fixation distal to the fracture 10–18 . Modular fluted tapered stems provide the added practical advantage of allowing length and anteversion adjustment after implantation of the distal fixation portion of the stem. Description: In this technique, a modified extended trochanteric osteotomy incorporating the fracture is utilized to gain access to the loose femoral implant and femoral diaphyseal canal. The femoral diaphyseal canal is then sequentially reamed in 1-mm increments. A fluted tapered stem with the appropriate length, diameter, and axial and rotational stability is inserted into the canal. A proximal body is then chosen that establishes the appropriate leg length, femoral offset, and version. The final proximal body is engaged into the fluted tapered stem. Finally, the fracture is fixed around the implant with a combination of cables or wires. Alternatives: Historically, implants such as extensively porous coated stems were utilized to treat Vancouver B2 or B3 periprosthetic femoral fractures. Unfortunately, these implants were associated with high rates of failure and revision 7,9 . Rationale: The introduction of a fluted tapered stem provided a more reliable implant that achieves immediate axial and rotational stability. In addition, utilizing a fluted tapered stem allowed for a more soft-tissue-preserving approach to these complex injuries, in turn allowing the fracture to be reduced around the implant proximally with cerclage cables and or wires. Modular fluted tapered stems provide the additional advantage of allowing the surgeon to modify leg length, offset, and femoral version, independently of the fluted tapered stem. As a result of these unique advantages, these stems were introduced several years ago for the treatment of Vancouver B2 or B3 periprosthetic femoral fractures. Expected Outcomes: Contemporary series have demonstrated that the use of a modular fluted tapered stem leads to improved implant survivorship and clinical outcomes with lower complication rates for Vancouver B2 and B3 periprosthetic femoral fractures 1,10–12,14–19 . Important Tips: Template both the fluted tapered stem and proximal body preoperatively. The proximal body should be templated at the ideal hip center of rotation that appropriately restores leg lengths and offset. Template the fluted tapered stem so that it provides appropriate isthmic fit and bypasses the most distal extent of the fracture by at least 2 cortical diameters.Utilize a modified extended trochanteric osteotomy for your exposure in order to facilitate visualization of the fracture and to provide direct access to the femoral canal.Place a prophylactic cable prior to preparing the femur for the implant in order to help prevent iatrogenic fracture.Place a trial stem and obtain intraoperative anteroposterior and lateral radiographs in order to assess the position of the implants and the risk of anterior cortical perforation.When placing the final implants, be sure the fluted tapered stem has both axial and rotational stability.Reduce and fix the fracture after the final implants are placed and the hip is reduced. Acronyms and Abbreviations: AP = anteroposteriorMFT = modular fluted tapered (stem)ETO = extended trochanteric osteotomyTHA = total hip arthroplastyCT = computed tomographyPJI = periprosthetic joint infection
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Scrimshire, A. B., A. Farrier, L. Kottam, R. Walker, S. Jameson i P. Baker. "O8 The COMPOSE Study: Characteristics, Outcomes and Management of PeriprOsthetic fractures: a Service Evaluation". BJS Open 5, Supplement_1 (1.04.2021). http://dx.doi.org/10.1093/bjsopen/zrab033.007.
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Abstract Introduction The number of peri-prosthetic fractures (PPF) is increasing, yet there still lacks a clear evidence-based strategy to best manage these injuries. There is a growing interest to collect a substantial body of information about PPFs in order to aid understanding of this population, current treatments and clinical outcomes. COMPOSE is a national multi-centre, retrospective service evaluation examining the incidence, management, outcomes and patient characteristics of those presenting to secondary care hospitals in the UK with a PPF. Methods Data will be collected via REDCap for all PPFs which presented to the orthopaedic departments between 1st January 2018 to 31st December 2018 from the participating hospitals. The evaluation will aim to collect pre-operative data (baseline demographics, fracture characteristics, surgical characteristics) and post-operative outcome data (length of stay, discharge, post-operative complications, re-admissions, re-operations, mortality). Results Currently, 24 hospital sites have registered with a total of 388 cases recorded. We continue to seek further interested sites to join. COMPOSE will generate a unique and robust dataset of PPFs and current practices. All data and outcomes will be reported descriptively. The outcome measures will be analysed using regression modelling with adjustment for baseline variables. Between group comparisons will be reported using confidence intervals and p-values. Conclusion Following analysis, the aim is to make supported recommendations regarding management, to help plan clinical services for this patient population and to assist with identification of potential risk factors for PPFs and the subsequent outcomes. The dataset will also aid development of testable hypotheses for future research.
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Chen, Alvin Chao-Yu, Chun-Jui Weng, Chih-Hao Chiu, Shih-Sheng Chang, Chun-Ying Cheng i Yi-Sheng Chan. "Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation". BMC Musculoskeletal Disorders 21, nr 1 (20.11.2020). http://dx.doi.org/10.1186/s12891-020-03767-4.
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Abstract Background Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury. Methods A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of 9 years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups. Results In patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS. Conclusions With an average of 9 years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.
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Stancil, Ryan, Jacob Romm, William Lack, Frank Bohnenkamp, Stephen Sems, William Cross, Joseph Cass i in. "Distal Femoral Replacement for Fractures Allows for Early Mobilization with Low Complication Rates: A Multicenter Review". Journal of Knee Surgery, 29.06.2021. http://dx.doi.org/10.1055/s-0041-1731353.
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AbstractPeriprosthetic fractures around a total knee arthroplasty (TKA), comminuted and intra-articular femur fractures, or fracture nonunions in osteoporotic bone represent technically challenging problems. This is particularly true when the fracture involves a loose femoral component or the pattern results in suboptimal fixation potential. These clinical indications often arise in an older and comorbid patient population in whom a principal goal of treatment includes allowing for early mobilization. Limited data indicate that arthroplasty via distal femoral replacement (DFR) is a reasonable alternative to open reduction and internal fixation, allowing for early ambulation with low complication rates. We performed a retrospective review of trauma and arthroplasty surgeries at three tertiary referral institutions. Adult patients treated for the above with a DFR were included. Patients with active infection, open and/or high-energy injuries and revisions unrelated to fracture were excluded. Patient demographics, treatment details, and outcomes were assessed. Between 2002 and 2017, 90 DFR's were performed for the above indications with a mean follow-up of 24 months. Postoperatively, 80 patients (88%) were allowed to weight bear as tolerated, and at final follow-up, 9 patients (10%) remained dependent on a wheelchair. The average arc of motion at final follow-up was 95 degrees. There were seven (8%) implant-related complications requiring secondary surgeries: two infections, one with associated component loosening; one fracture of the hinge mechanism and one femoral component failure in conjunction with a patellofemoral dislocation (both requiring revision); one case of patellofemoral arthrosis in a patient with an unresurfaced patella; one periprosthetic fracture with associated wound dehiscence; and one case of arthrofibrosis. In each of these cases, only modular components of the DFR were exchanged. All nonmodular components cemented into the femur or tibia were retained. DFR provides a viable reconstruction option in the treatment of acute distal femur fractures, periprosthetic femur fractures, and fracture nonunions. We noted that in an elderly patient population with high comorbidities, the complication and secondary surgery rates remained relatively low, while allowing for immediate weight bearing.
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Patel, Arpit, Anouska Ayub, Farhad Iranpour i Padmanabhan Subramanian. "Fixation and Implant Retention of Extracapsular Femoral Neck Periprosthetic Fractures Around Hip Resurfacing Arthroplasty – A Case Series". JOURNAL OF ORTHOPAEDIC CASE REPORTS 11, nr 7 (10.07.2021). http://dx.doi.org/10.13107/jocr.2021.v11.i07.2336.
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Introduction: Background: Extracapsular femoral neck fractures in the presence of a resurfacing hip arthroplasty (RHA) appear to be independent of suboptimal technique during the initial implantation of the RHA and present with a similar etiology as native hip fractures – that is, a fragility fracture related to pathological or age-related osteoporosis, as a consequence of trauma. In the presence of a well-fixed and previously well-functioning RHA, the options for management include revision arthroplasty or open reduction and internal fixation (ORIF). In the absence of loosening through mechanisms of wear, infection, metallosis, or suboptimal prosthesis positioning, many authors have advocated ORIF with implant retention. However, there is often debate regarding the use of total hip arthroplasty in these cases Case Series: The authors conducted a thorough assessment of the literature followed by a retrospective review of outcomes for three patients treated by ORIF with implant retention for extracapsular femoral neck fractures around a RHA, using a standardized technique. All patients were independently mobile and active with well-fixed and well-functioning RHAs before the date of injury. All patients suffered low-energy trauma resulting in the fracture. There were no intraoperative or perioperative complications. All patients achieved full weight-bearing status and independent mobility. Two patients achieved radiographic union and returned to full range of movement and independent mobilization comparable to their preoperative state. One patient was lost to follow-up. Conclusion: The authors believe that fixation of extracapsular proximal femoral fractures distal to a well-fixed, well-functioning RHA is a good management option in an independent and active patient. A higher level of evidence is needed to investigate the surgical management options of these injuries comparing osteosynthesis with revision arthroplasty. Keywords: Periprosthetic fracture, hip resurfacin
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Halkiadakis, Penelope, Jason Ina, Blaine Bafus, Adrienne Lee i Bhargavi Maheshwer. "Poster 184: Demographics and Outcomes of Shoulder Instability in Individuals with Elevated Body Mass Index". Orthopaedic Journal of Sports Medicine 11, nr 7_suppl3 (1.07.2023). http://dx.doi.org/10.1177/2325967123s00170.
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Objectives: Traumatic shoulder dislocations in the adolescent, active adult, and elderly have been well studied. However, to our knowledge, no specific study has investigated the characteristics and outcomes of anterior shoulder dislocations in morbidly obese individuals. The objective of this study is to describe shoulder dislocations in patients with body mass index (BMI) greater than 40. Methods: A retrospective chart review was performed to identify patients 18 years of age and older with a BMI greater than or equal to 40 who presented with a shoulder dislocation within a single institution from 2000-2020 were included in this study. Patients who had a BMI of less than 40, sustained a periprosthetic shoulder dislocation, and patients who were pregnant were excluded from this study. Dislocation pattern, associated injuries, treatment modalities, and associated complications were recorded. Complications were defined to include recurrent instability as demonstrated by a single recurrent dislocation event, infection, arthrofibrosis, and associated neurovascular injury. Results: Seventy-seven patients were included in our study. Fifty-two patients (67.5%) were female. Average age was 47.95 ± 2.06 (range 18-81), with average BMI of 45.01 ± 5.67 (range 40-78). Mean follow up for our patient cohort was 411.5 days (1.13 years). Sixty-five dislocations (84%) were due to a ground level fall whereas 8 (10%) were due to assault and 4 (5%) were due to a motor vehicle collision (MVC) (p<0.01). There was a significant increase in the number of patients with BMI greater than 40 presenting per year (r2 = - 0.831, p < 0.01) over the past 20 years. In addition, there was also a significant increase in the average BMI per year in this population (r2 = 0.504, p=0.028). Fifteen patients (19.5%) experienced at least one recurrent dislocation episode, with average time to recurrent dislocation of 449 days (1.23 years). Hill-Sachs lesions were the most common associated injury (p=0.03). Bankart lesions were the only associated injury that were found to be associated with an elevated BMI (p = 0.04), Nine patients (11.7%) sustained an associated neurologic injury which was found to have no association with BMI. There were 56 patients (72.7%) who were managed non-operatively and 21 patients (27.3%) who underwent surgical intervention. One patient failed nonoperative management and arthroscopic stabilization, going on to require shoulder arthrodesis and biceps tenodesis. They subsequently developed a post-operative infection necessitating revision arthrodesis. Conclusions: Over time, there has been an increase in shoulder dislocations in morbidly obese individuals in the United States, alongside an overall increase in the average BMI of patients who present with shoulder dislocations. These injuries most commonly happen due to low energy mechanisms and can be associated with Bankart lesions and associated neurologic injuries. There was a recurrent dislocation rate of 19.5%, which is consistent with this age cohort. As the current trend continues it will become increasingly important to better understand these injuries. Morbidly obese patients may incur higher health care costs and resource expenditure to treat such injuries. In addition, appropriate patient education and outcome expectations for nonoperative and operative treatment should be provided given the high risk of recurrent dislocations in this patient population.
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Pica, Giuseppe, Francesco Liuzza, Mario Ronga, Luigi Meccariello, Domenico De Mauro, Amarildo Smakaj, Enio De Cruto i Giuseppe Rollo. "Interprosthetic and interimplant femoral fractures: is bone strut allograft augmentation with ORIF a validity alternative solution in elderly?" Orthopedic Reviews 14, nr 6 (13.10.2022). http://dx.doi.org/10.52965/001c.38558.
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Background Nowadays orthopedic surgeons have a new challenge to treat the interimplants fractures. Although fixation strategies exist for periprosthetic hip and knee fractures, there is no standard of care regarding the more complex interprosthetic and interimplants fractures. Objective The aim of our study is targeting the focus on the bone strut grafting to avoid the metal hardware failure and to achieve the bone healing in these injuries. Methods A prospective case note review of all interprosthetic or interimplants femoral fractures admitted to our trauma center. There were 11 patients (2 males and 9 females) with a mean age over 85 years old. We treated all the patients by ORIF and medial graft strut allograft to reduce the main complication leading to re-operations and morbidity or mortality is the nonunion or delayed union. The criteria to evaluate the patients during the follow-up were: the survival and complication after the surgery; the objective quality of life measured by Activities of Daily Living Score (ADL). The bone healing was measured by X-rays control as the alignment was measured by radiographic UNION SCORE, and postoperative complications. Results All the patients reduced their ADL. In the most of cases we had a good x-rays reduction. We had not: No nonunion or Not delayed union. All patients died within 2 years from the surgery but not due by surgical complications. Conclusions According us, the purpose of this surgery is to limit comorbidities and early mortality not to improve optimal restoration of lower limb function.
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Duvvuri, Priya, Sally May Trout, Christine Decker Bub i Ariel Tenny Goldman. "Use of a Hindfoot Nail Without Separate Subtalar and Tibiotalar Joint Preparation to Treat Geriatric Ankle and Distal Tibia Fractures: A Case Series". Geriatric Orthopaedic Surgery & Rehabilitation 14 (12.08.2023). http://dx.doi.org/10.1177/21514593231195239.
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Introduction Ankle fractures in geriatric patients can be devastating injuries, as they limit an individual’s mobility, autonomy, and quality of life. This study examines the functional outcomes and complications related to hindfoot nails (HFN) in geriatric patients who have suffered an ankle malleolar or distal tibia fracture. Materials and Methods This is a single-surgeon case-series of patients who underwent HFN for acute fixation or delayed reconstruction after an ankle or distal tibia fracture. Demographic information, comorbidities, baseline functional status, AO/OTA classification, surgical indications, need for external fixation, total operative time, length of stay (LOS), ambulation at discharge, and discharge disposition were recorded. Primary outcomes included 30-day complications, ambulation at follow-up, and time to fracture union and fusion. Results There were 22 patients, with average age 80.8 years. Mean LOS was 7.0 days, and 68.2% were discharged to subacute rehabilitation. Within 30 days, 1 patient developed a deep vein thrombosis and bilateral pulmonary emboli, and 2 experienced wound dehiscence requiring antibiotics. At 6-weeks, 1 patient sustained a fall with periprosthetic fracture requiring HFN revision, and another developed cellulitis necessitating hardware removal. Fracture healing was seen in 72.7% at 19.4 weeks, while radiographic fusion occurred in 18.2% at 43.0 weeks. 72.7% were ambulating with an assistive device at discharge, and 100.0% at 12-weeks post-operatively or last follow-up. Upon final examination, all patients were ambulating without pain. Discussion HFNs provide a reliable alternative to traditional open reduction internal fixation and have the ability to improve quality of life for geriatric patients through a faster return to weight-bearing. Additionally, radiographic fusion rates show that patients have favorable functional outcomes even without formal arthrodesis. Conclusion HFN is beneficial for elderly patients with low functional demand and complex medical comorbidities, as it allows for early mobility after sustaining an ankle or distal tibia fracture.
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Haghverdian, Justin, Christopher E. Gross i Andrew R. Hsu. "Periprosthetic Fracture After Hindfoot Fusion Nail Treated With Spanning Antegrade Tibial Nail". Foot & Ankle Specialist, 19.01.2022, 193864002110643. http://dx.doi.org/10.1177/19386400211064384.
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Periprosthetic fracture after hindfoot fusion nailing is a complex, uncommon complication. There is no consensus in the literature regarding optimal treatment of these injures, with proposed solutions, including cast immobilization, retrograde femoral and humeral nails, circular external fixation, and amputation. The goal of revision surgery is to adequately bypass and stabilize the fracture, protect the hindfoot fusion site from increased stress, and promote early weight bearing in a load-sharing fashion. In this report, we present the case of an unstable periprosthetic tibia fracture involving the proximal aspect of a hindfoot fusion nail 10 weeks after surgery in the setting of an incompletely fused hindfoot. The patient was successfully treated using a spanning antegrade suprapatellar tibia nail extending from the proximal aspect of the tibia to the plantar aspect of the calcaneus to bypass the tibia fracture as well as protect and maintain fixation across the hindfoot fusion. At final follow-up, the patient had union across her tibia fracture as well as her hindfoot fusion and was able to return to her activities of daily living and ambulate in normal shoe wear. Level of Evidence: Level V
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Baba, Tomonori, Masataka Uchino, Hironori Ochi, Takuya Ikuta, Yoshitomo Saita, Hiroshi Hagino, Hiroaki Nonomiya i in. "Atypical periprosthetic femoral fractures after arthroplasty for fracture are at high risk of complications". Scientific Reports 11, nr 1 (13.07.2021). http://dx.doi.org/10.1038/s41598-021-93574-1.
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AbstractIt is difficult to investigate clinical features in a single-center study because atypical periprosthetic femoral fracture (APFF) is rare. This study aims to perform a nationwide survey of APFF to investigate the characteristics of this fracture and compare the clinical outcome with that of typical periprosthetic femoral fracture (typical PFF). A nationwide survey was performed asking for cooperation from 183 councilors of the Japanese Society for Fracture Repair. The subjects were patients with APFF injured between 2008 and 2017. The control group was comprised of patients with typical PFF of our facility injured in the same period. A total of 43 patients met the APFF definition. The control group was comprised of 75 patients with typical PFF. The rate of bisphosphonate use was significantly higher in the APFFs group than in the typical PFF group (62.8% and 32%, p < 0.02). The rate of cemented stem was significantly higher in the APFFs group than in the typical PFF group (30.2% and 6.7%, p < 0.001). In the patients with arthroplasty for hip fracture, multivariable logistic regression analyses showed that APFF was an independent risk factor of complications following the initial management (Odds ratio 11.1, 95% confidence interval 1.05–117.2, p = 0.045). However, no significant association between PFF and APFF was observed in the patients with arthroplasty for other hip diseases. The risk of complications was higher in the APFF group than in the typical PFF group in the patients with arthroplasty for fracture. When AFPP after arthroplasty for the fracture is suspected, it may be necessary to add not only internal fixation with a normal plate but also some additional treatment.
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Sekeitto, Allan Roy, Kaeriann van der Jagt, Nkhodiseni Sikhauli i Dick Ronald van der Jagt. "Total knee replacement in Osteogenesis Imperfecta: a case report and review of the literature". Arthroplasty 3, nr 1 (2.04.2021). http://dx.doi.org/10.1186/s42836-020-00061-5.
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Abstract Background A review of the literature revealed that only 9 total knee replacements were performed on patients with osteogenesis imperfecta (OI), with one being a revision procedure of a periprosthetic fracture. Of the 9 primary procedures, all used cemented prostheses, and 3 patients had an osteotomy at the same procedure. Our patient required a hinged prosthesis because of collateral ligament incompetence and is the first such case reported in the literature. Case presentation Presented here is a total knee replacement performed on a 52-year-old patient with osteogenesis imperfecta (OI) who injured her left knee and ruptured her anterior cruciate ligament. Her right knee suffered from severe degenerative changes with an incompetent medial collateral ligament. It was decided to replace the right knee before addressing the left knee injury. A hinged revision prosthesis was used. The smallest components available were used because of the small anatomical bony dimensions. Conclusion This is the first reported case of a hinged prosthesis and highlights the soft tissue component of osteogenesis imperfecta. We also highlight the technical problems with these patients, including mal-alignment, small bony dimensions and bone fragility.