• Journal of the Korean Orthopaedic Association
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• v.56 no.3
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• pp.200-207
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• 2021

Periprosthetic femoral fractures remain as one of the most challenging complications following total hip arthroplasty. A thorough clinical and radiographic evaluation, precise classification, and understanding of modern management principles are essential to obtain optimal results for these fractures. The Vancouver classification system is a simple, effective, and reproducible method for the planning treatments of these injuries. The fractures associated with a stable femoral stem can be treated effectively with osteosynthesis, but periprosthetic femoral fractures associated with a loose stem require revision arthroplasty. This paper describes the principle of the treatment of patients with periprosthetic femoral fractures and how to assess the stability of the femoral stem.

• Journal of Biomedical Engineering Research
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• v.25 no.6
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• pp.455-464
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• 2004

Total hip arthroplasty(THA) considerably depends on high-experienced doctors because of high difficulty of the operation. Selection of acetabular cup's and femoral implant's position is closely related with success or failure of THA. Nevertheless the selection has usually depended on doctor's eye measurement, which makes the position accuracy of artificial joint lower after THA, often resulting in revision of THA. The present study determined a method to select accurately the position of acetabular cup and femoral implant through surgical simulation with 3D characteristic geometrical information of patient's pelvis and femur. We examined the change of femoral anteversion angle and neck-shaft angle accompanied by the change of acetabular cup's position and the insertion position of femoral implant. As result of analyzing geometrical information through different surgical simulations, we found that it was possible to select the accurate position of acetabular cup and femoral implant. It is expected to help doctors get experienced in THA operation through repetitive surgical simulations using the method suggested in the study.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.89-96
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• 2024

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.

• Hip & pelvis
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• v.35 no.4
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• pp.217-227
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• 2023

Purpose: Periprosthetic femoral fracture (PFF) is a common complication after total hip arthroplasty, and open reduction and internal fixation (ORIF) is a common surgical treatment. We conducted a meta-analysis to compare the outcomes of ORIF in patients with different fracture patterns (Vancouver B1 and B2). Materials and Methods: We conducted a systematic search of PubMed, Embase, Cochrane Library and KoreaMed from inception to August 2022. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the 10 comparative studies and a proportional meta-analysis on the data from the 39 articles to determine a consensus. The outcomes were the incidence of reoperations that included osteosynthesis, irrigation/debridement and revision arthroplasty. Results: The pair-wise meta-analysis showed similar outcomes between two groups; the risk of reoperation (odds ratio [OR]=0.82, confidence interval [CI] 0.43-1.55, P=0.542), nonunion (OR=0.49; CI 0.22-1.10, P=0.085) and deep infection (OR=1.89, CI 0.48-7.46, P=0.361). In proportion meta-analysis, pooled prevalence of reoperation was 9% (95% CI, 6-12) in B1 and 8% (95% CI, 2-15) in B2 (heterogeneity between two groups (Q), P=0.772). The pooled prevalence of nonunion was same as of 4% in B1 and B2 (Q, P=0.678), and deep infection was 2% (95% CI, 1-3) in B1 and 4% (95% CI, 2-7) in B2 (Q, P=0.130). Conclusion: ORIF is a feasible treatment for B1 and B2 periprosthetic femoral fractures, with acceptable outcomes in terms of, nonunion and infection. The results of this study would help clinicians and provide baseline data for further studies validating PFF.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.11-22
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• 1985

Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture In itself were noted, but we have analyzed 18 femur neck fractures of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slip-down accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and Internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. 4 undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with pre-existing disease in the same hip Joint (total hip replacement).