Clinic for Trauma, Orthopaedic and Sports Medicine, Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Germany.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):119-126. doi: 10.1007/s00590-023-03629-4. Epub 2023 Jun 26.
Periprosthetic femoral fractures (PFF) according to type Vancouver C are less common and outcome is limited reported. Therefore, we conducted this retrospective single center study.
We performed analysis of patients who underwent open reduction and internal fixation (ORIF) with locking plates for PPF occurring distally of a primary standard hip stem. Data on demographics, revisions, fracture patterns, and mortality were evaluated. At least two years after operation, we examined outcome using the Parker and Palmer mobility score. Primary aim of this study was revision, outcome and mortality. Secondary aim was evaluation of fracture subtypes within type Vancouver C fractures.
Between 2008 and 2020, 383 patients with periprosthetic femoral fracture after hip replacement were surgically treated according to our database. Among them, 40 patients (10.4%) with type Vancouver C fractures were enrolled for this study. The mean patient age was 81.5 years (59-94) at the time of fracture. Thirty-three patients were women, and 22 fractures were on the left side. Without exception, locking plates were used. The 1-year mortality rate for the sample was 27.5% (n = 11). Three revisions (7.5%) were performed for plate breakage. Rate of infection and non-union was zero. Three different fracture patterns were assessed: (1) transverse or oblique fractures below the tip of the stem (n = 9); (2) spiral-shaped fractures within the diaphysis (n = 19); and (3) burst fractures at the supracondylar region (n = 12). Demographic or outcome effects between fracture patterns were not found. On average of 4.2 years (2.0-10.4) after treatment, the mean reported Parker score was 5.5 (1-9).
ORIF with a single lateral locking plate is safe for type Vancouver C fractures with a well-fixed hip stem. Therefore, we do not recommend routinely revision arthroplasty or orthogonal double plating. Three subtypes of fractures within Vancouver C demonstrated no significant differences in baseline data and outcome.
根据温哥华 C 型的分类，股骨假体周围骨折（PFF）较为少见，且其预后报道有限。因此，我们进行了这项回顾性单中心研究。
我们分析了因髋关节标准主干近端发生假体周围股骨骨折而接受切开复位内固定（ORIF）联合锁定钢板治疗的患者。评估了患者的人口统计学资料、翻修情况、骨折类型和死亡率。术后至少 2 年，我们使用 Parker 和 Palmer 活动评分评估了患者的预后。本研究的主要目的是评估翻修、预后和死亡率，次要目的是评估温哥华 C 型骨折中的骨折亚型。
根据我们的数据库，2008 年至 2020 年期间，383 例髋关节置换术后发生股骨假体周围骨折的患者接受了手术治疗，其中 40 例（10.4%）温哥华 C 型骨折患者被纳入本研究。骨折发生时，患者的平均年龄为 81.5 岁（59-94 岁）。33 例为女性，22 例发生在左侧。无一例外，所有患者均使用了锁定钢板。该样本的 1 年死亡率为 27.5%（n=11）。有 3 例（7.5%）患者因钢板断裂而进行了翻修。感染和不愈合的发生率均为 0。评估了 3 种不同的骨折类型：（1）位于主干尖端下方的横形或斜形骨折（n=9）；（2）骨干内螺旋形骨折（n=19）；和（3）髁上区爆裂骨折（n=12）。未发现骨折类型与患者的人口统计学资料或预后之间存在关联。治疗后平均 4.2 年（2.0-10.4 年）时，平均 Parker 评分报告为 5.5（1-9）。
对于股骨主干固定良好的温哥华 C 型骨折，使用单一外侧锁定钢板的 ORIF 是安全的。因此，我们不建议常规进行关节翻修或正交双钢板固定。温哥华 C 型骨折中的 3 种亚型在基线资料和预后方面无显著差异。
