Periprosthetic fracture

Approach

• Difficult problem, challenging, needs MDT approach
• Carries high mortality (89% 1 year survival)
• After establishing the history and examn, and the patient requirements, I will consult with the territory revision centre because treatment involves requirement of specialised instruments and implants which may not be available at a centre where it is not routinely done.
• How ever the Principles are
  • Preop planning
    • Classify
    • template
    • Be prepared with specialised implants and instrumentation
  • Aim is stable fixation, soft tissue preserve, early mobilisation and functional recovery

Classification

Vancouver

• Duncan and Masri
• A: Fracture at trochanters
  • A L
  • A G

B

• Around to tip of implant
• Loosening and Bone stock
• B1: Well fixed stem
• B2: Loose stem
• B3: Loose with poor proximal bone stock

C

• C: well below stem

New

• D: with Knee replacement
• E: stem with acetabulum
• F: Hemi with Acetabulum

Challenges

• Predispose to future fracture
• Implant impairs healing
• Structural changes in bone
• Implants block fixation

GT

• Intra op
  • Assess abdutor attachment
• Post op:
  • wide displaced, fix
  • undisplced: non surgical

B

• Status of implant
• Proximal bone stock
• Intra operative decision
• Lateral position to assess
• If sure supine
• Well fixed: fix with cable plate and BG
• Span the femur
• Loose/ poor bone stock: Revise/bone graft

C

• stress raisers

Cables

• Strong in bending
• poor in torsion
• so use screws
• use less number as softissue stripping needed