Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Atypical Vancouver B1 periprosthetic fracture of the proximal femur in the United Kingdom: a case report challenged by myeloma, osteoporosis, infection, and recurrent implant failures

  • Sayantan Saha (Department of Trauma and Orthopaedics, North Manchester General Hospital) ;
  • Azeem Ahmed (Department of Trauma and Orthopaedics, North Manchester General Hospital) ;
  • Rama Mohan (Department of Trauma and Orthopaedics, North Manchester General Hospital)
  • Received : 2023.09.26
  • Accepted : 2024.01.29
  • Published : 2024.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

The indications for total hip replacement are increasing and not limited to osteoarthritis. Total hip replacement may also be done for trauma and pathological fractures in patients otherwise physiologically fit and active. This trend has led to an inevitable rise in complications such as periprosthetic femoral fracture. Periprosthetic femoral fracture can be challenging due to poor bone quality, osteoporosis, and stress fractures. We present a case of periprosthetic femoral fracture in a 71-year-old woman with some components of an atypical femoral fracture. The fracture was internally fixed but was subsequently complicated by infection, implant failure needing revision, and later stress fracture. She was on a bisphosphonate after her index total hip replacement surgery for an impending pathological left proximal femur fracture, and this may have caused the later stress fracture. Unfortunately, she then experienced implant breakage (nonunion), which was treated with a biplanar locking plate and bone grafting. The patient finally regained her premorbid mobility 13 months after the last surgery and progressed satisfactorily towards bony union.

Keywords

References

  1. NJR Reports. Hips: revision procedures: patient characteristics [Internet]. UK National Joint Registry; 2021 [cited 2021 Sep 18]. Available from: https://reports.njrcentre.org.uk/hips-revision-procedures-patient-characteristics
  2. Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 2004;(420):80-95.
  3. Ramavath A, Lamb JN, Palan J, Pandit HG, Jain S. Postoperative periprosthetic femoral fracture around total hip replacements: current concepts and clinical outcomes. EFORT Open Rev 2020;5:558-67. https://doi.org/10.1302/2058-5241.5.200003
  4. Shane E, Burr D, Ebeling PR, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2010;25:2267-94.
  5. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2014;29:1-23. https://doi.org/10.1002/jbmr.1998
  6. Chen F, Bhattacharyya T. Periprosthetic fracture of the femur after long-term bisphosphonate use: a case report. JBJS Case Connect 2012;2:e21.
  7. Schaeffer JF, Attarian DE, Wellman SS. Periprosthetic femoral insufficiency fracture in a patient on long-term bisphosphonate therapy. The Duke Orthop J 2012;2:66-9. https://doi.org/10.5005/jp-journals-10017-1021
  8. Robinson Jde D, Leighton RK, Trask K, Bogdan Y, Tornetta P 3rd. Periprosthetic atypical femoral fractures in patients on long-term bisphosphonates: a multicenter retrospective review. J Orthop Trauma 2016;30:170-6. https://doi.org/10.1097/BOT.0000000000000508
  9. Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br 2009;91:1424-30. https://doi.org/10.2106/JBJS.H.01335
  10. Pavlou G, Panteliadis P, Macdonald D, et al. A review of 202 periprosthetic fractures: stem revision and allograft improves outcome for type B fractures. Hip Int 2011;21:21-9. https://doi.org/10.5301/hip.2011.6301
  11. Chakrabarti D, Thokur N, Ajnin S. Cable plate fixation for Vancouver type-B1 periprosthetic femoral fractures: our experience and identification of a subset at risk of non-union. Injury 2019;50:2301-5. https://doi.org/10.1016/j.injury.2019.10.012
  12. Kharazmi M, Michaelsson K, Hallberg P, Schilcher J. Lateral fixation: an alternative surgical approach in the prevention of complete atypical femoral fractures. Eur J Orthop Surg Traumatol 2018;28:299-304.
  13. Chatziagorou G, Lindahl H, Karrholm J. Surgical treatment of Vancouver type B periprosthetic femoral fractures: patient characteristics and outcomes of 1381 fractures treated in Sweden between 2001 and 2011. Bone Joint J 2019;101-B:1447-58. https://doi.org/10.1302/0301-620X.101B11.BJJ-2019-0480.R2