Service de chirurgie orthopédique et de traumatologie, hôpital Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
Orthop Traumatol Surg Res. 2010 Feb;96(1):44-8. doi: 10.1016/j.rcot.2009.11.002.
Type C periprosthetic femoral fractures present fixation problems related to the extent of the fracture and the quality of the bone stock.
The authors report a continuous and prospective series of type C periprosthetic femoral fractures to assess the mechanical stability of the femoral implant and the clinical outcome at the medium term.
Between April 2004 and November 2006, we treated 17 patients (15 females, two males) presenting a prosthetic hip fracture (12 cases), between the hip prosthesis and the knee (one case), and with a knee prosthesis (four cases). All the implants had no sign of loosening at the time of fracture. The patients' mean age was 76.7 years (range, 39-93 years). Internal fixation was obtained with a locking compression plate (LCP) Synthes bridging the implant in place to prevent a weak zone. The rehabilitation protocol consisted in full weight bearing as much as possible.
The mean follow-up of the series was 31.5 months (range, 4-51 months). Four deaths were recorded during the follow-up. Minimally invasive surgery was performed in 15 patients.Total loading was possible immediately in 10 patients, partial loading at 20 kg in three patients,and no loading was possible until 6 weeks in four patients. Two infections and a bending-type mechanical complication of the plate secondary to a fall were observed. Consolidation was obtained in all cases with the appearance of callus formation beginning in the 6th week.
The technique used allies the principle of closed internal fixation (with preservation of the fracture hematoma) with mechanical stability. The screws locking to the plate warrant an internal fixator with increased stability that is sufficient for early loading with no risk of losing the secondary axis. Despite this increased rigidity, we did not observe any particular stress on the femoral implants. We recommend bridging the implant and spaced locking for better distribution of the stresses during loading. This hardware, with, if possible, insertion using a reduced approach, seems adapted to periprosthetic femoral fractures, particularly in the elderly.
Level IV, prospective therapeutic study.
C 型假体周围股骨骨折存在与骨折范围和骨质量相关的固定问题。
作者报告了一系列连续的 C 型假体周围股骨骨折病例，以评估股骨植入物的机械稳定性和中期临床结果。
2004 年 4 月至 2006 年 11 月，我们治疗了 17 名患者（15 名女性，2 名男性），其中包括 12 例假体髋部骨折、1 例位于髋关节假体和膝关节之间、4 例膝关节假体。所有植入物在骨折时均无松动迹象。患者平均年龄为 76.7 岁（范围 39-93 岁）。内固定采用锁定加压钢板（LCP）Synthes 桥接固定以防止出现薄弱区。康复方案包括尽可能完全负重。
该系列的平均随访时间为 31.5 个月（范围 4-51 个月）。随访期间有 4 例死亡。15 例患者行微创外科手术。10 例患者可立即完全负重，3 例患者可负重 20kg，4 例患者 6 周内不能负重。发生 2 例感染和 1 例因跌倒导致钢板弯曲型机械并发症。所有病例均获得愈合，第 6 周开始出现骨痂形成。
该技术结合了闭合内固定（保留骨折血肿）的原则和机械稳定性。锁定螺钉与钢板连接可增加稳定性，足以在无失去二次轴风险的情况下早期负重。尽管这种刚性增加，我们没有观察到股骨植入物有任何特殊的应力。我们建议桥接植入物并采用间隔锁定，以在负重时更好地分布应力。这种硬件，如果可能的话，采用微创入路插入，似乎适应于假体周围股骨骨折，特别是在老年人中。
IV 级，前瞻性治疗研究。
Zotero 插件