Modern trends in the treatment of periprosthetic femur fractures

P.I. Bilinsky, B.I. Palamar, O.V. Drobotun, V.A. Andreychyn, E.O. Shishko, S.L. Vichrov

Abstract


Background. One of the complications of endoprosthetic replacement is periprosthetic femur fracture (PFF). The last one occurs intraoperatively during endoprosthesis revision (ER) and at any time after surgery. Currently, there is no consensus in choosing the optimal treatment method in periprosthetic fractures and means for its implementation. Most often, osteosynthesis is performed using various plates and cerclages. The purpose of the work was to analyze the current trends in PFF treatment and means for their implementation. Materials and methods. We conducted a detailed biomechanical analysis of situations that arise during PFF. Published data were studied, as well as 27 cases with such a problem. In 4 patients, PFF had appeared during the initial arthroplasty, after surgery 9 patients had broken femur, during ER — 8 and after it — 6 patients. The most positive results were obtained, when the method of treatment was determined on the basis of the Vancouver classification of PFF. It is important to evaluate the interaction of femur fragments and prosthetic legs and the processes that take place at this junction. Proper understanding of the biomechanical results of this interaction dynamics allows getting a good result in most cases. Results. The most common method of surgical PFF treatment is fragment fixation by different cerclages: wire, cable, band, cerclages with platforms. Indication for this method of treatment is type B2 fracture, when the leg is unstable, and bone has good quality. It is also indicated at intraoperative fractures type A and B1. Application of cerclages without platforms leads to suppuration, aseptic instability of leg, femur fracture. We observed this complication in 3 cases. Better results in B2, B3 fractures are provided by combined osteosynthesis with gear plate, which stabilizes fragments of the femur by band cerclages. Conclusions. PFF treatment is a complex social and medical problem. It is associated with a variety of complex biomechanical and clinical situations that arise in this case. Only a detailed analysis and selection of the most optimal methods and fixation device can provide positive results. This issue requires further comprehensive investigation.

Keywords


periprosthetic femur fractures; methods of surgical treatment

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DOI: https://doi.org/10.22141/1608-1706.2.18.2017.102564

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