ORLANDO, Fla. — Management of periprosthetic fractures should be dealt with on a case by case basis, according to a presentation here.
“[Periprosthetic fractures are] a troublesome epidemic,” Fares S. Haddad, MCh(Orth), FRCS, said at the Current Concepts in Joint Replacement Winter Meeting. “The best treatment is undoubtedly to avoid them in the first place … A rational system, where if the stem is stable and you get good biomechanical fixation, is to go ahead with internal fixation. If it is loose, then revision is the way forward.”
When managing periprosthetic fractures, Haddad noted it is important surgeons know where the fracture is, whether the implant is well-fixed or loose and the quality of the bone stock.
“You can also ask yourself whether that implant was functional before and how fit the patient is for surgery because that will modify your thinking slightly,” Haddad said.
However, he added, there is not a single treatment that can be applied to all periprosthetic fractures.
According to Haddad, type A fractures should either be fixed around the greater trochanter to avoid escape or around the lesser trochanter, depending on the size of the fragment and how far it extends. Type B1 fractures are reduced and fixed, type B2 fractures are revised and fixed and type B3 fractures undergo a bigger revision.
“[Type B fractures] are the fractures you need to be worried about and these are the ones where we need to substratify as whether the implant is secure, whether it is loose or whether it is loose with poor bone stock, because that guides treatment,” Haddad said.
Trauma principles apply to type C fractures. Management needs to be optimized for type D and E fractures, while type F fractures are managed based on their stability, he noted.
“All total hips are at risk. We need to take great care, particularly in specific cases where the bone is osteopenic, and we need to be particularly aware of new implants and new approaches and always expect the unexpected,” Haddad said. – by Casey Tingle
Haddad FS. Paper #20. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 9-12, 2015; Orlando, Fla.
Disclosure: Fares is on the editorial or governing board for the Annals of the Royal College of Surgeons England, the Bone and Joint Journal, the Journal of Arthroplasty and Orthopaedics Today Europe; receives royalties from Corin, Smith & Nephew and MatOrtho; is a paid consultant and received research support from Smith & Nephew; and is a paid consultant for Stryker.