|
Year |
2002 |
|---|---|
|
Question Number |
15 |
|
Category |
Musculoskeletal Trauma |
Question
An otherwise healthy 66-year-old woman has right thigh pain and is unable to bear weight after falling. The patient underwent a primary total hip arthroplasty 12 years ago and has had gradually worsening start-up pain for the past 2 years. Radiographs are shown in Figures 3a and 3b. Management should consist of
1. traction followed by functional bracing
2. open reduction, dual strut bone grafting, and cable fixation with component retention.
3. open reduction and plating (cerclage wires proximal, screws distal) with component retention.
4. revision to a long-stem femoral component with strut bone grafting and cables.
5. impaction grafting after internal fixation of the fracture.
Figures
Answer (click for answer)
Preferred response: 4
The radiograph reveals a fracture at the distal aspect of the cemented femoral stem. The clinical scenario tells us the component is loose (start-up pain). This would classify as a Vancouver B3 fracture (Loose stem with severe comminution, generalized osteopenia, or severe osteolysis). Following is a chart for treatment of periprosthetic THA femur fractures.
Vancouver A (Trochaneric fractures, Greater or Lesser)
Stable-Nonsurgical
Unstable-ORIF
Vancouver B (Around or just below stem)
B1(Component stable)-Plating and/or strut graft
B2(Loose Component with good bone stock)
Revision to long stem uncemented prosthesis with bone grafting
B3(Loose Component with poor bone stock)
Revision to long stem prosthesis with bone grafting, may need tumor prosthesis or allograft composite.
Vancouver C (Well distal to stem)-Fracture can be treated independently of prosthesis
Reference: Koval, KJ (ed): OKU 7. Rosemont IL, American Academy of Orthopaedic Surgeons, 2002, pp 434-435.