Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom.
Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom.
Orthop Traumatol Surg Res. 2019 Jun;105(4):587-589. doi: 10.1016/j.otsr.2018.08.022. Epub 2019 Feb 8.
Interprosthetic fractures occur between a total knee replacement and a femoral stem of either a hemiarthroplasty or total hip replacement. The number of interprosthetic fractures will increase as the number of joint replacements rises. There is currently a paucity of literature looking at the outcomes of interprosthetic fractures. Therefore, we performed a retrospective study to: (1) determine fracture union in patients following surgical treatment of a femoral interprosthetic fracture, (2) measure outcomes included mortality and complications.
Favoring bone fixation instead of prosthetic revision gives an acceptable rate of reoperation.
A retrospective case note review of all interprosthetic femoral fractures admitted to a tertiary trauma centre over a 7-year period. There were 24 patients (4 males and 20 females) with a mean age of 82.3 (65-98). The initial operative procedure was a total hip replacement (THR) and a total knee replacement (TKR) in 19 patients, one THR and revision TKR, four hip hemiarthroplasty and TKR. There were 23 cemented femoral stems, and 1 uncemented femoral stem. The median time to surgery was 84hours. The median length of hospital stay was 16 days. Nineteen patients underwent open reduction internal fixation and 1 of these used a strut graft. Two patients underwent revision knee replacements and 3 underwent a revision hip replacement. All patients had at least 2 years clinical follow-up.
One patient died within 30 days of fracture, leaving 23 patients to assess bone union. Another patient died within 1 year of fracture. Three out of 24 patients (12.5%) suffered a complication that required further surgery. The fracture united in 19/23 (82.6%) of patients and the 2-year mortality rate was 5/24 (20.8%).
Interprosthetic fractures are complex fractures occurring in elderly patients with multiple medical comorbidities. Whenever possible bone fixation instead of prostehtic revision give a low rate of complication and reoperation. The surgical treatments are complex, but with a well-performed surgical technique and an adequate rehabilitation program can result in satisfactory outcomes.
IV, retrospective case series.
假体间骨折发生于全膝关节置换与半髋关节或全髋关节置换的股骨柄之间。随着关节置换数量的增加，假体间骨折的数量将会增加。目前，关于假体间骨折的研究结果很少。因此，我们进行了一项回顾性研究，以：（1）确定手术治疗股骨假体间骨折患者的骨折愈合情况，（2）测量包括死亡率和并发症在内的结果。
支持骨固定而非假体翻修可获得可接受的再手术率。
对 7 年来三级创伤中心收治的所有股骨假体间骨折患者的病历进行回顾性分析。共有 24 名患者（4 名男性和 20 名女性），平均年龄 82.3 岁（65-98 岁）。初次手术为全髋关节置换术（THR）和全膝关节置换术（TKR）的有 19 例，THR 和 TKR 翻修各 1 例，髋关节半髋关节置换术和 TKR 各 4 例。有 23 例股骨柄为骨水泥固定，1 例为非骨水泥固定。手术中位数时间为 84 小时。中位住院时间为 16 天。19 例行切开复位内固定，其中 1 例行支撑植骨。2 例患者行膝关节翻修，3 例患者行髋关节翻修。所有患者均获得至少 2 年的临床随访。
1 例患者在骨折后 30 天内死亡，23 例患者可评估骨折愈合情况。另 1 例患者在骨折后 1 年内死亡。24 例患者中有 3 例（12.5%）发生需要进一步手术的并发症。23 例患者中的 19 例（82.6%）骨折愈合，2 年死亡率为 5/24（20.8%）。
假体间骨折是发生在有多种合并症的老年患者中的复杂骨折。只要可能，骨固定而非假体翻修可降低并发症和再手术率。手术治疗复杂，但如果手术技术良好，康复计划充分，可获得满意的结果。
IV，回顾性病例系列。
