Intramedullary stabilization of periprosthetic fractures of the femur taking special account of bone defects.
OBJECTIVE
Healing of the periprosthetic fracture and area of defective bone by the bone healing mechanisms of intramedullary stabilization. Reconstruction of the correct length, axial alignment, and rotation of the fractured femoral shaft by anchoring a revision stem in the intact femoral diaphysis.


METHODS
Periprosthetic femoral shaft fracture in the region of the prosthetic stem combined with preexistent loosening and/or defect in the periprosthetic bone bed (Vancouver classification type B2 and B3).


METHODS
General contraindications, local infection.


METHODS
Lateral transmuscular approach to the femoral shaft. Longitudinal osteotomy of the proximal femur taking the geometry of the fracture into account. Opening of an anterior "bone shell". Removal of the loose prosthetic stem and cement. Debridement. Preparation of the femoral diaphysis and insertion of a distally anchored revision stem. Distal locking. Repositioning of the "bone shell", reduction of the fracture, and retention with cerclage wires.


METHODS
Bed rest for approximately 1 week, mobilization with 20 kg partial weight bearing for 12 weeks, gradual increase in weight bearing with radiologic checks on progress, removal of the distal locking bolts after 12-24 months at the earliest.


RESULTS
21 patients (13 women, eight men) aged between 43 and 86 years (mean age: 71.2 years) with periprosthetic fracture of the femur, additional loosening of the stem in eight cases (Vancouver B2) and additional bone loss in 13 cases (Vancouver B3). Postoperative complications: two fractures following another fall (repeat operations: one replacement, one plate), four revisions due to subsidence of the stem (three replacements involving change to a standard stem with healed proximal femur, one replacement with another interlocked revision stem). Bone healing occurred for all fractures after a mean 5.6 months (3-11 months). Follow-up examination after a mean 4.5 years: all patients were able to walk, average Harris Score 70.5 points (29-95 points).
Eingartner
Christoph
C
Abteilung für Unfall- und Wiederherstellungschirurgie, Caritas-Krankenhaus, Bad Mergentheim. christoph.eingartner@ckbm.de
Volkmann
Rüdiger
R
Ochs
Uwe
U
Egetemeyr
Daniel
D
Weise
Kuno
K
D000077:Acetabulum / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D001842:Bone and Bones / Q000601:surgery*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011182:Postoperative Care; D011300:Preoperative Care; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome