Stručni rad

https://doi.org/10.20471/acc.2017.56.03.21

Treatment of Periprosthetic Femoral Fractures after Total Hip Arthroplasty Vancouver Type B

Nikola Bulatović ; Clinical Center of Montenegro, Clinical Department of Orthopedic Surgery and Traumatology, Podgorica, Montenegro
Miroslav Kezunović ; Clinical Center of Montenegro, Clinical Department of Orthopedic Surgery and Traumatology, Podgorica, Montenegro
Čedomir Vučetić ; Clinical Center of Serbia, Clinical Department of Orthopedic Surgery and Traumatology, Belgrade, Serbia
Nermin Abdić ; Clinical Center of Montenegro, Clinical Department of Orthopedic Surgery and Traumatology, Podgorica, Montenegro
Ivan Benčić ; Sestre milosrdnice University Hospital Center, Clinical Department of Traumatology, Zagreb, Croatia
Tomislav Čengić ; Sestre milosrdnice University Hospital Center, Clinical Department of Traumatology, Zagreb, Croatia; University of Applied Health Sciences, Zagreb, Croatia

Sažetak

Th e rate of periprosthetic femoral fractures following total hip replacement has been growing steadily in the last 20 years and ranges from 0.1% to 2.1%. These fractures are mostly related to older patients with the presence of chronic diseases and frequently poor bone quality. Th e treatment is surgically very complex and demanding, followed by a series of complications. Th e evaluation in this retrospective study included 23 patients who were medically treated from January 2004 to December 2015 with the mean follow-up of 14.5 (range, 9-25) months. Th ere were 17 patients with cement total hip arthroplasty (THA) and 6 with cementless THA. During treatment of fractures, different techniques were implemented including the use of wire cerclage, dynamic compression plates (DCP), a locking compression plate (LCP) system, and long revision stem. For the purpose of distinguishing fractures, we used the Vancouver classifi cation by Duncan and Masri. For clinical evaluation, we used the modifi ed Merle d’Aubigne score system and monitored complications during treatment. Th e aim is to show treatment results of the type B periprosthetic femoral fractures by using diff erent operative treatment techniques. According to the Vancouver classifi cation within type B, 10 (43.47%) patients had type B1 fractures, another 10 (43.47%) patients had type B2 fractures, and three (13.04%) patients had type B3 fractures. According to gender distribution, there were eight (34.8%) male and 15 (65.2%) female patients, mean age 59.5 (range, 47-86) years. Twelve (52.2%) and 11 (47.8%) patients had left- and right-sided fractures, respectively. Th e mean length of hospital stay was 16 (range, 9-26) days. According to the Merle d’Aubigne score system, 10 patients with type B1 fractures had the mean score of 11.5 points, which is poor result. Poor result was also recorded in patients with type B2 fractures, with the mean score of 10.6 points. Th e three patients with type B3 fractures had the mean score of 12 points, which is considered fair score. In conclusion, Vancouver classifi cation has been widely accepted and using the protocols makes decision making during treatment much easier. During treatment of this type of fracture, we used various implants, wire cerclage, DCP and LCP, as well as long stem revision. In certain cases, we applied surgical techniques, implants that are not recommended by the Vancouver protocol by which we treated periprosthetic femoral fractures; in these case, we recorded nonunion bone, malunion and breaking of implants, which resulted in poor treatment outcome.

Ključne riječi

Total hip arthroplasty; Periprosthetic femoral fractures; Vancouver classification; Complications

Hrčak ID:

191679

URI

https://hrcak.srce.hr/191679

Datum izdavanja:

1.9.2017.

Podaci na drugim jezicima: hrvatski

Posjeta: 3.221 *