Fraile Gamarra Inés, Jiménez Viseu Pinheiro Juan Fernando, Cano Gala Carlos, Blanco Blanco Juan Francisco
Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente 58-182, 37001, Spain.
Int J Surg Case Rep. 2019;64:174-176. doi: 10.1016/j.ijscr.2019.10.012. Epub 2019 Oct 12.
Total hip arthroplasty in young patients can cause problems when it comes to choosing a suitable implant. The Birmingham Mid-Head Resection prosthesis (BMHR) offers the option of preserving bone stock despite its poor quality in the femoral neck. Femoral neck fractures are a known complication of hip resurfacing prostheses and the main reason for revision surgery. Retaining the femoral implant may cause difficulties in osteosynthesis carried out with implants habitually used for intertrochanteric or femoral neck fractures (e.g., a screw-plate device or a cephalomedullary nail) [2].
We present the case of an 81-year-old patient who underwent surgery for right hip osteoarthritis and received a Birmingham Mid-Head Resection prosthesis. She had no history of previous fractures due to frailty. While on holiday, she sustained a periprosthetic fracture as a result of a fall. While the most common fracture in resurfacing prosthesis is produced in the femoral neck, in this case the patient sustained a subtrochanteric fracture. This fracture was surgically treated by means of open reduction and internal fixation with trochanteric plate and three cerclages.
Olsen et al. [8] described two fracture patterns: transcervical vertical shear type and subcapital type. In our patient's case, the fracture pattern was different to those described, as the fracture started in the cervical area and reached the subtrochanteric area. This change in the standard periprosthetic fracture pattern leads to a change in the therapeutic attitude that must be adopted.
BMHR prostheses are metal-on-metal implants that resulted from the development of the standard resurfacing prostheses used to treat hip osteoarthritis in young patients with the goal of preserving as much bone stock as possible. In this paper we will describe a rare complication in this type of prosthesis and how it was surgically treated after reviewing the available literature.
对于年轻患者而言，全髋关节置换术在选择合适的植入物时可能会引发问题。伯明翰中头切除假体（BMHR）提供了保留骨量的选择，尽管其股骨颈骨质质量较差。股骨颈骨折是髋关节表面置换假体已知的并发症，也是翻修手术的主要原因。保留股骨植入物可能会给习惯用于转子间或股骨颈骨折的植入物（如螺钉钢板装置或髓内钉）进行骨固定带来困难[2]。
我们呈现一例81岁患者的病例，该患者因右髋骨关节炎接受手术并植入了伯明翰中头切除假体。她因身体虚弱既往无骨折史。度假期间，她因跌倒发生了假体周围骨折。虽然表面置换假体最常见的骨折发生在股骨颈，但该病例中患者发生的是转子下骨折。该骨折通过切开复位并用转子钢板和三道环扎带进行内固定手术治疗。
奥尔森等人[8]描述了两种骨折类型：经颈垂直剪切型和头下型。在我们患者的病例中，骨折类型与所描述的不同，因为骨折始于颈部区域并延伸至转子下区域。这种标准假体周围骨折类型的变化导致必须采取的治疗态度发生改变。
BMHR假体是金属对金属的植入物，是为治疗年轻髋骨关节炎患者的标准表面置换假体发展而来，目的是尽可能多地保留骨量。在本文中，我们将描述这种假体的一种罕见并发症以及在查阅现有文献后其手术治疗方法。
