Centre for Hip Surgery, Wrightington Hospital, Wigan, UK.
J Arthroplasty. 2020 May;35(5):1344-1350. doi: 10.1016/j.arth.2020.01.020. Epub 2020 Jan 18.
The aim of this study is to present our experience in managing fractured femoral stems over the last 10 years for both primary and revision stems at our tertiary unit focusing on modes of failure and operative techniques.
This is a retrospective consecutive study of all patients with fractured femoral stems that were operatively managed in our unit between 2008 and 2018. Detailed radiographic evaluation (Paprosky classification) was undertaken and data collected on operative techniques used to extract distal fractured stem fragments.
Thirty-five patients (35 hips) were included (25 men/10 women) with average age at time of presentation of 68 years (range, 29-93). Average body mass index was 30 (standard deviation, 3.8; range, 22.5-39). There were variety of stems both contemporary and historical, primary and revision cases (15 hips polished tapered cemented stems, 10 hips composite beam and miscellaneous stems, and 10 revision hip stems). The predominant mechanism of failure was fatigue due to cantilever bending in distally fixed stems. Surgical techniques used to extract distal fragment were drilling technique in 2 hips, cortical window in 13 hips, extended trochanteric osteotomy (ETO) in 5 hips, and proximal extraction in 15 hips.
When faced with a contemporary fractured stem, drilling techniques into the distal fragment are unlikely to succeed. If a trochanteric osteotomy had been used at time of index surgery, this could be used again to aid proximal extraction with conventional revision instrumentations. The cortical window technique is useful but surgically demanding technique that is most successful in extracting polished tapered fractured stems particularly when an ETO is not planned for femoral reconstruction. Use of trephines can be useful for removal of longer, uncemented stems. Finally, an ETO might be necessary when other techniques have failed.
本研究旨在介绍我们在过去 10 年中在我们的三级单位管理原发性和翻修股骨柄骨折的经验，重点介绍失败模式和手术技术。
这是一项回顾性连续研究，纳入了 2008 年至 2018 年期间在我们单位接受手术治疗的所有股骨柄骨折患者。对所有患者进行详细的影像学评估（Paprosky 分类），并收集用于提取远端骨折柄片段的手术技术数据。
共纳入 35 例患者（35 髋）（25 例男性/10 例女性），就诊时的平均年龄为 68 岁（范围 29-93 岁）。平均体重指数为 30（标准差 3.8；范围 22.5-39）。有各种不同类型的股骨柄，包括现代和历史的、原发性和翻修的（15 髋抛光锥形水泥股骨柄、10 髋复合梁和其他股骨柄、10 髋翻修股骨柄）。主要的失败机制是由于远端固定的股骨柄悬臂弯曲导致的疲劳。用于提取远端碎片的手术技术包括 2 髋钻孔技术、13 髋皮质窗技术、5 髋延长转子间截骨术（ETO）和 15 髋近端提取技术。
当遇到现代股骨柄骨折时，向远端碎片钻孔技术不太可能成功。如果在指数手术时使用了转子间截骨术，那么可以再次使用该技术，结合常规翻修器械，辅助近端提取。皮质窗技术是一种有用但手术要求较高的技术，对于提取抛光锥形骨折股骨柄特别有用，特别是当计划不进行股骨重建的 ETO 时。使用环锯对于去除较长的非骨水泥股骨柄可能有用。最后，当其他技术失败时，可能需要进行 ETO。
