title: Intramedullary strut substitution and impaction allografting cemented revision for the treatment of a periprosthetic fracture in a severely compromised femur.
abstract: Revision for the treatment of a B3 periprosthetic femoral fracture often requires proximal femoral allograft arthroplasty in physiologically young or tumor prostheses in elderly patients. Extramedullary strut allograft augmentation can only be used when the host femur is structurally adequate for the insertion of the revision stem (periprosthetic femoral fractures type B2) and appears to be an attractive biological concept as early incorporation to the host bone results in a sound biomechanical construct. We report here the simultaneous use of whole femur intramedullary strut substitution along with an extramedullary strut graft placement, with impaction allografting revision to a long cemented femoral prosthesis, to augment the deficient metadiaphyseal bone stock (Paprosky type IV) for the treatment of a complex type B3 periprosthetic femoral fracture.
authors.affiliation: Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital NHS Trust, Exeter, United Kingdom.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis
authors.forename: Amir A
authors.initials: AA
authors.lastname: Narvani
authors.forename: John
authors.initials: J
authors.lastname: Charity
authors.forename: John A
authors.initials: JA
authors.lastname: Timperley
authors.forename: Graham A
authors.initials: GA
authors.lastname: Gie
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002484:Cementation; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D011859:Radiography; D012086:Reoperation; D014184:Transplantation, Homologous