T Mittlmeier1, M Beck2, U Bosch3, A Wichelhaus4. 1. Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland. thomas.mittlmeier@med.uni-rostock.de. 2. Klinik für Orthopädie und Unfallchirurgie, St. Bernward Krankenhaus, Treibestraße 9, 31134, Hildesheim, Deutschland. 3. International Neuroscience Institute, INI Hannover GmbH, Rudolf-Pichlmayr-Str. 4, 30625, Hannover, Deutschland. 4. Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland.
Abstract
BACKGROUND: The cumulative incidence of periprosthetic fractures around the knee is increasing further because of an extended indication for knee replacement, previous revision arthroplasty, rising life expectancy and comorbidities. AIM OF THE WORK: The relevance of local parameters such as malalignment, osseous defects, neighbouring implants, aseptic loosening and low-grade infections may sometimes be hidden behind the manifestation of a traumatic fracture. A differentiated diagnostic approach before the treatment of a periprosthetic fracture is of paramount importance, while the physician in-charge should also have particular expertise in fracture treatment and in advanced techniques of revision endoprosthetics. The following work gives an overview of this topic. RESULTS: Valid classifications are available for categorising periprosthetic fractures of the femur, the tibia and the patella respectively, which are helpful for the selection of treatment. CONCLUSIONS: With the wide-ranging modern treatment portfolio bearing in mind the substantial rate of complications and the heterogeneous functional outcome, the adequate analysis of fracture aetiology and the corresponding transformation into an individualised treatment concept offer the chance of an acceptable functional restoration of the patient at early full weight-bearing and prolonged implant survival. The management of complications is crucial to the final outcome.
BACKGROUND: The cumulative incidence of periprosthetic fractures around the knee is increasing further because of an extended indication for knee replacement, previous revision arthroplasty, rising life expectancy and comorbidities. AIM OF THE WORK: The relevance of local parameters such as malalignment, osseous defects, neighbouring implants, aseptic loosening and low-grade infections may sometimes be hidden behind the manifestation of a traumatic fracture. A differentiated diagnostic approach before the treatment of a periprosthetic fracture is of paramount importance, while the physician in-charge should also have particular expertise in fracture treatment and in advanced techniques of revision endoprosthetics. The following work gives an overview of this topic. RESULTS: Valid classifications are available for categorising periprosthetic fractures of the femur, the tibia and the patella respectively, which are helpful for the selection of treatment. CONCLUSIONS: With the wide-ranging modern treatment portfolio bearing in mind the substantial rate of complications and the heterogeneous functional outcome, the adequate analysis of fracture aetiology and the corresponding transformation into an individualised treatment concept offer the chance of an acceptable functional restoration of the patient at early full weight-bearing and prolonged implant survival. The management of complications is crucial to the final outcome.
Entities:
Keywords:
Femur; Osteosynthesis; Patella; Tibia; Total knee replacement
Authors: Bill Ristevski; Aaron Nauth; Dale S Williams; Jeremy A Hall; Daniel B Whelan; Mohit Bhandari; Emil H Schemitsch Journal: J Orthop Trauma Date: 2014-05 Impact factor: 2.512