Young-Hoo Kim1, Sameer Ajit Mansukhani2, Jun-Shik Kim2, Jang-Won Park2. 1. The Joint Replacement Centers, Ewha Womans University, SeoNam Hospital, Seoul, Republic of Korea. 2. The Joint Replacement Centers, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea.
Abstract
BACKGROUND: The purpose of this study was to determine: validated clinical and radiographic outcomes of periprosthetic femoral fractures around stable hip implants treated with plate fixation and additional cortical strut onlay allografts without revision of the stem; radiographic signs of fracture healing; allograft-to-host bone union; resorption of cortical strut allograft; and frequency of complications. METHODS: At our institute, 24 patients (25 hips) were identified with Vancouver type B1 fracture at the tip of the femoral stem and one patient (one hip) was identified with a Vancouver type C fracture of the femur. All these fractures were treated with combined use of locking plate fixation and cortical strut onlay allografts. There were 18 women and 7 men, with an average age of 63 years. Harris hip score and University of California, Los Angeles activity score were used to assess postoperative function. The average duration of follow-up was 3.7 years (range, 1-7 years). RESULTS: Harris hip score at final review was 86 points (range, 65-95 points). University of California, Los Angele activity score averaged 5.8 ± 1.3 point (range, 3.5-10 points) at final follow-up. All but 2 patients returned to their preoperative functional level within 1 year. Twenty-three of 26 hips had fracture union following the first operation. Three hips were failed to obtain fixation because of insufficient length of plate and allograft. Cortical strut onlay allografts were incorporated in the host femur in all hips by one year. Minor resorption of allograft was noticed, but there was no failure of any of the cortical strut allografts. CONCLUSION: The cortical strut onlay allografts facilitated the mechanical stability and the biological fracture healing in addition to plate fixation.
BACKGROUND: The purpose of this study was to determine: validated clinical and radiographic outcomes of periprosthetic femoral fractures around stable hip implants treated with plate fixation and additional cortical strut onlay allografts without revision of the stem; radiographic signs of fracture healing; allograft-to-host bone union; resorption of cortical strut allograft; and frequency of complications. METHODS: At our institute, 24 patients (25 hips) were identified with Vancouver type B1 fracture at the tip of the femoral stem and one patient (one hip) was identified with a Vancouver type C fracture of the femur. All these fractures were treated with combined use of locking plate fixation and cortical strut onlay allografts. There were 18 women and 7 men, with an average age of 63 years. Harris hip score and University of California, Los Angeles activity score were used to assess postoperative function. The average duration of follow-up was 3.7 years (range, 1-7 years). RESULTS: Harris hip score at final review was 86 points (range, 65-95 points). University of California, Los Angele activity score averaged 5.8 ± 1.3 point (range, 3.5-10 points) at final follow-up. All but 2 patients returned to their preoperative functional level within 1 year. Twenty-three of 26 hips had fracture union following the first operation. Three hips were failed to obtain fixation because of insufficient length of plate and allograft. Cortical strut onlay allografts were incorporated in the host femur in all hips by one year. Minor resorption of allograft was noticed, but there was no failure of any of the cortical strut allografts. CONCLUSION: The cortical strut onlay allografts facilitated the mechanical stability and the biological fracture healing in addition to plate fixation.
Authors: Nicola Mondanelli; Elisa Troiano; Andrea Facchini; Roberta Ghezzi; Martina Di Meglio; Nicolò Nuvoli; Giacomo Peri; Pietro Aiuto; Giovanni Battista Colasanti; Stefano Giannotti Journal: Geriatr Orthop Surg Rehabil Date: 2022-05-10