Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
Arch Orthop Trauma Surg. 2014 Jan;134(1):9-14. doi: 10.1007/s00402-013-1883-6. Epub 2013 Nov 20.
Periprosthetic femur fractures are a growing problem in the geriatric population. This study examines Vancouver B1 periprosthetic femur fractures treated with open reduction internal fixation using a laterally based plate. Outcomes using plates which spanned the length of the femur to the level of the femoral condyles were compared to those which did not. The hypothesis was that spanning internal fixation would result in a decreased rate of refracture and subsequent reoperation.
Patients admitted to three affiliated academic hospitals treated with open reduction internal fixation for a periprosthetic femur fracture in the setting of a preexisting total hip arthroplasty or hemiarthroplasty stem were identified. Patient data were reviewed for age, gender, fracture classification, operative intervention, time to union, as well as complications related to treatment and need for further surgery.
Over a 5-year period, 58 patients were treated with open reduction internal fixation using a laterally based plate for Vancouver B1 femur fractures. Twenty-one patients were treated with plates that extended to the level of the femoral condyles. In that group there were no nonunions or subsequent periprosthetic fractures reported. Of 36 patients treated with short plates, 3 went on to nonunion resulting in plate failure and refracture and 2 sustained a subsequent fracture distal to the existing fixation.
In this series, fixation for periprosthetic femur fractures around a well-fixed arthroplasty stem which spans the length of the femur to the level of the femoral condyles is associated with a decreased rate of nonunion and refracture. By decreasing the rate of refracture and nonunion, spanning fixation decreases the morbidity and mortality associated with additional surgery in a fragile geriatric population.
在老年人群中，股骨假体周围骨折是一个日益严重的问题。本研究检查了使用外侧支撑板进行切开复位内固定治疗的温哥华 B1 股骨假体周围骨折。比较了跨越股骨长度至股骨髁水平的钢板和未跨越的钢板的结果。假设是，跨越内固定将降低再骨折和随后再次手术的发生率。
确定了在先前存在全髋关节置换术或半髋关节置换术柄的情况下，因股骨假体周围骨折而在三家附属学术医院接受切开复位内固定治疗的患者。对患者数据进行了回顾，包括年龄、性别、骨折分类、手术干预、愈合时间，以及与治疗相关的并发症和进一步手术的需要。
在 5 年期间，58 名患者因温哥华 B1 股骨骨折接受了外侧支撑板切开复位内固定治疗。21 名患者接受了延伸至股骨髁水平的钢板治疗。在该组中，没有报告非愈合或随后的假体周围骨折。在接受短钢板治疗的 36 名患者中，有 3 名发生了不愈合，导致钢板失败和再骨折，有 2 名发生了现有固定物远端的后续骨折。
在本系列中，跨越股骨长度至股骨髁水平的固定良好的关节置换柄周围的股骨假体周围骨折固定与非愈合和再骨折的发生率降低相关。通过降低再骨折和非愈合的发生率，跨越固定降低了在脆弱的老年人群中进行额外手术相关的发病率和死亡率。
