Pal Chandra Prakash, Singh Pulkesh, Kumar Deepak, Singh Arpit
Department of orthopaedics, SNMC, Agra, India.
Department of Orthopaedics, U.P RIMS & R, Saifai, Etawah, India.
J Orthop Case Rep. 2014 Jul-Sep;4(3):12-5. doi: 10.13107/jocr.2250-0685.185.
Fractures involving bones containing a component of a prosthetic joint are becoming more common. The causation is multifactorial but most of these injuries are associated with trivial trauma. The options available for operative management of these fractures include internal fixation of the fracture alone, fixation of the fracture with revision of the prosthesis, and reconstruction of proximal femur with either modified impaction bone grafting or proximal femoral replacement.
We present here a case of periprosthetic fracture Vancouver type B1 with a broken cemented bipolar prosthesis insitu, in which the broken implant was firmly fixed in the proximal fragment and could not be removed following which the whole of the proximal fragment along with the broken implant was removed and replaced by a customized steel long stem cemented mega prosthesis.
This case is being presented on account of its unusual presentation and fracture pattern. A broken prosthesis along with a periprosthetic fracture is not a common incident. Thus the treatment had to be individualized. Since the prosthesis was well fixed, its broken stem could not be removed from the proximal fragment and so the whole of the proximal fragment along with stem was removed and replaced with a long stem custom made bipolar prosthesis.
涉及包含人工关节部件骨骼的骨折正变得越来越常见。其病因是多因素的，但这些损伤大多与轻微创伤有关。这些骨折的手术治疗选择包括单纯骨折内固定、骨折固定并假体翻修，以及采用改良嵌压植骨或股骨近端置换术重建股骨近端。
我们在此呈现一例温哥华B1型假体周围骨折病例，骨折处有一个原位断裂的骨水泥型双极假体，断裂的植入物牢固地固定在近端骨折块中且无法取出，随后将整个近端骨折块连同断裂的植入物一并取出，并用定制的带骨水泥的超长柄钢质假体进行替换。
之所以展示该病例是因其表现及骨折类型不同寻常。假体断裂并伴有假体周围骨折并非常见情况。因此治疗必须个体化。由于假体固定良好，其断裂的柄无法从近端骨折块中取出，所以将整个近端骨折块连同柄一并取出，并用定制的带长柄双极假体进行替换。
