Washington University Orthopaedics, St. Louis, MO, USA.
J Orthop Trauma. 2010 Dec;24(12):740-4. doi: 10.1097/BOT.0b013e3181d73508.
Interprosthetic femoral fractures, ones occurring between ipsilateral total hip and total knee arthroplasties, are an increasingly common and challenging problem for orthopaedic surgeons. The purpose of this study was to report specific fracture locations and treatment outcomes associated with a protocol of femoral plate fixation that spanned the interprosthetic zone applied with modern soft tissue preserving reduction techniques without adjuvant bone grafts.
Retrospective cohort study.
One Level I and one Level II trauma center.
PATIENTS/PARTICIPANTS: A consecutive cohort of 25 patients with 26 interprosthetic femur fractures surgically treated by one of four orthopaedic traumatologists were retrospectively reviewed. There were nine fractures of the femoral shaft (Orthopaedic Trauma Association [OTA] 32) about hip arthroplasty prostheses and 17 supracondylar fractures (OTA 33) about total knee prostheses. Five patients with six fractures were excluded as a result of lack of follow up (n = 4) or deviation from the treatment protocol (n = 2). The remaining 20 fractures were all low-energy closed injuries in elderly patients (average age 80 years; range, 56-98 years; 14 females and six males).
A common surgical treatment protocol included plate fixation that spanned the entire interprosthetic zone (overlapping the stem proximally and knee component distally) and the use of biologic tissue-preserving plating techniques without use of supplemental bone grafts of any kind.
Fracture healing, time to full weightbearing, malunion, nonunion, and the presence of any hardware failure.
Supracondylar interprosthetic fracture patterns (OTA 33A) were two times more common than proximal diaphyseal fractures (OTA 32) (Vancouver B), 65% versus 35%. All 20 fractures healed after the index procedure. The average time to weightbearing as tolerated was 13 weeks (range, 6-22 weeks). There were three malunions (one 10° valgus, one 9° extension, and one 10° flexion), two cases of painful implants (one required removal), and one loose long-stem revision hip prosthesis (required total femur replacement). All other implants remained well-fixed. All complications occurred in patients with supracondylar fracture patterns. There were no additional associated peri-implant fractures.
Interprosthetic femoral fractures tend to occur more frequently in the supracondylar region about total knee arthroplasty components than in the diaphysis about hip stems. Modern biologic plating techniques that span the entire interprosthetic zone to eliminate additional stress risers show reliable union rates without the use of adjuvant bone graft while maintaining limb alignment and implant survivorship.
发生在同侧全髋关节和全膝关节置换之间的假体间股骨骨折，是骨科医生面临的一个日益常见且具有挑战性的问题。本研究的目的是报告与一种股骨钢板固定方案相关的特定骨折部位和治疗结果，该方案跨越假体间区域，应用现代软组织保留复位技术，不使用辅助骨移植物。
回顾性队列研究。
一家一级和一家二级创伤中心。
患者/参与者：连续的 25 例假体间股骨骨折患者，由 4 位骨科创伤医生中的 1 位进行手术治疗，其中 9 例为股骨骨折（创伤骨科协会 [OTA] 32 型），位于髋关节假体附近，17 例为髁上骨折（OTA 33 型），位于全膝关节假体附近。由于缺乏随访（n = 4）或不符合治疗方案（n = 2），5 例患者的 6 处骨折被排除在外。其余 20 处骨折均为老年患者的低能量闭合性损伤（平均年龄 80 岁；范围，56-98 岁；女性 14 例，男性 6 例）。
一种常见的手术治疗方案包括使用跨越整个假体间区域（近端覆盖股骨柄，远端覆盖膝关节组件）的钢板固定，并使用不使用任何类型的辅助骨移植物的生物组织保留钢板技术。
骨折愈合、完全负重时间、畸形愈合、不愈合以及任何内固定失败的发生。
髁上假体间骨折（OTA 33A）的发生率是近端骨干骨折（OTA 32，Vancouver B）的两倍（65%比 35%）。所有 20 处骨折在初次手术后均愈合。平均负重时间为 13 周（范围，6-22 周）。有 3 例畸形愈合（1 例 10°外翻，1 例 9°伸展，1 例 10°屈曲），2 例植入物疼痛（1 例需要取出），1 例松动的长柄翻修髋关节假体（需要全股骨置换）。所有其他植入物均保持固定良好。所有并发症均发生在髁上骨折患者中。没有其他与植入物相关的骨折。
与髋关节柄假体附近的骨干相比，髁上区域更常发生假体间股骨骨折。跨越整个假体间区域以消除额外的应力集中的现代生物力学钢板技术，在不使用辅助骨移植物的情况下，显示出可靠的愈合率，同时保持肢体对线和植入物存活率。
