Pathologic fractures: a complication of microparticulate synovitis.
We report seven cases of pathologic fracture in adult patients that were seen an average of 5 years (range from 33 to 114 months) after silicone wrist (three) and trapezial (four) arthroplasty. All patients had initially done well after their operation. At return, all had radiographic evidence of generalized implant and intramedullary bone destruction, the latter always including endosteal scalloping and widening from cortical resorption. These radiographic changes may be less striking than the discrete osteolytic lesions seen after degeneration of carpal implants. Our patients represent examples of pathologic fracture as the end stage of untreated microparticulate synovitis, a consequence of prosthetic wear. Our experience suggests that careful and continuous follow-up justified after insertion of stemmed silicone implants, and that patients should be informed of the potential late complications of this procedure, including pathologic fracture.
Department of Orthopaedic Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York.
C A
CA
Peimer
J
J
Taleisnik
F S
FS
Sherwin
D000368:Aged; D002348:Carpal Bones / Q000293:injuries*; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology; D005598:Fractures, Spontaneous / Q000209:etiology*; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D012826:Silicone Elastomers / Q000009:adverse effects*; D013585:Synovitis / Q000209:etiology*; D014954:Wrist Injuries / Q000209:etiology*
D012826:Silicone Elastomers