Periprosthetic Fracture Management

Title Page

Copyright

Editorial

Foreword

Acknowledgments

Contributors

Abbreviations

Table of contents

1 Introduction to periprosthetic fractures

1 Introduction to periprosthetic fractures

2 Epidemiology of periprosthetic fractures

2.1 Introduction

2.2 Hip

2.2.1 Acetabular fractures

2.2.2 Femoral fractures

2.3 Knee

2.3.1 Femoral fractures

2.3.2 Tibial fractures

2.3.3 Patellar fractures

2.4 Shoulder, elbow, wrist, and ankle

2.5 Conclusions

3 Causes of and risk factors for periprosthetic fractures

3.1 Age

3.1.1 Orthogeriatric patients with a periprosthetic fracture

3.1.2 Treatment goals in elderly patients

3.1.3 Preoperative assessment in elderly patients

3.1.4 Frailty syndrome

3.1.5 Sarcopenia

3.1.6 Malnutrition

3.1.7 Osteoporosis

3.1.8 Problems related to medication

3.1.9 Delirium

3.1.10 Conclusions

3.2 Arthroplasty

3.2.1 Common surgical hazards

3.2.2 Risks due to lack of preoperative planning

3.2.3 Risks associated with intraoperative technique

3.2.4 Risk of shoulder or elbow fractures

3.2.5 Risk of wrist fractures

3.2.6 Risk of acetabular fractures

3.2.7 Risk of femoral fractures

3.2.8 Risk of patellar fractures

3.2.9 Risk of tibial fractures

3.2.10 Risk of ankle fractures

4 Diagnosis of periprosthetic fractures

4.1 Assessment

4.1.1 Introduction

4.1.2 Clinical suspicion

4.1.3 Assessment of the fracture

4.1.4 Assessment of the patient

4.1.5 Value of diagnostic imaging

4.1.6 Conclusions

4.2 Classification

4.2.1 Introduction

4.2.2 Unified Classification System (UCS)

4.2.3 Classification of periprosthetic fractures according to anatomical regions

4.2.4 Summary

5 Management techniques for periprosthetic fractures

5.1 Introduction

5.1.1 Decision making

5.1.2 Preoperative planning and patient assessment

5.1.3 Postoperative management

5.2 Patient preparation

5.2.1 Introduction

5.2.2 Influence of preexisting clinical conditions

5.2.3 Postoperative planning

5.3 Nonoperative treatment

5.3.1 General conditions and indications

5.3.2 Shoulder

5.3.3 Elbow

5.3.4 Wrist

5.3.5 Hip

5.3.6 Knee

5.3.7 Ankle

5.4 Internal fixation

5.4.1 Plate fixation

5.4.2 Intramedullary nailing

5.5 Revision of prosthetic components

5.6 Alternative techniques

5.6.1 Indications that require alternatives

5.6.2 Alternative solutions for special scenarios

6 Periprosthetic fractures in specific anatomical locations

6.1 Shoulder

6.1.1 Incidence and risk factors

6.1.2 Classification

6.1.3 Preoperative planning

6.1.4 Timing of surgery

6.1.5 Choice of approach

6.1.6 Treatment

6.1.7 Complications and outcome

6.2 Elbow

6.2.1 Introduction

6.2.2 Classification

6.2.3 Treatment

6.2.4 Complications and outcome

6.3 Wrist

6.3.1 Introduction

6.3.2 Epidemiology

6.3.3 Incidence and risk factors

6.3.4 Classification

6.3.5 Treatment

6.3.6 Complications and outcome

6.4 Hip

6.4.1 Introduction

6.4.2 Pelvis and acetabulum

6.4.3 Proximal femur

6.5 Knee

6.5.1 Introduction

6.5.2 Distal femur

6.5.3 Patella

6.5.4 Proximal tibia

6.6 Ankle

6.6.1 Introduction

6.6.2 Incidence

6.6.3 Classification

6.6.4 Treatment

6.6.5 Complications and outcome

7 Shoulder cases

7.1 Proximal humeral fracture, stable prosthesis Nonoperative treatment: immobilization

7.2 Humeral shaft fracture, stable prosthesis ORIF: bridging LCP 4.5/5.0

7.3 Humeral shaft fracture, stable prosthesis ORIF: proximal humerus LCP 3.5

7.4 Humeral shaft fracture, stable prosthesis ORIF: double plating with LCPs 3.5 and 2.7

7.5 Humeral shaft fracture, stable prosthesis ORIF: LCP 4.5/5.0 and LAP

7.6 Humeral shaft fracture, stable prosthesis ORIF: LCP 4.5/5.0 and LAP

7.7 Humeral shaft fracture, stable prosthesis ORIF: LCP 4.5/5.0 and cerclage wires

7.8 Humeral shaft fracture, stable prosthesis ORIF: LCP 4.5/5.0 and cerclage wires

7.9 Surgical neck fracture after humeral surface replacement ORIF: PHILOS

7.10 Segmental humeral shaft fracture, stable prosthesis ORIF: metaphyseal LCP 3.5/4.5 and two reconstruction plates

7.11 Proximal humeral fracture, loose reverse prosthesis Revision: replacement of prosthesis stem

7.12 Humeral shaft malunion, loose prosthesis Revision: long-stem reverse arthroplasty

7.13 Humeral shaft fracture, stable prosthesis ORIF: LCP 4.5/5.0

7.14 Humeral shaft fracture, stable prosthesis ORIF: LCP 4.5/5.0 and cerclage wires

8 Elbow cases

8.1 Distal humeral fracture, loose elbow prosthesis Reconstruction: allograft prosthetic composite and plate fixation

8.2 Lateral humeral condyle fracture with impeding humeral fracture, loose prosthesis Reconstruction: allograft struts and impaction grafting, cerclage fixation

8.3 Proximal ulnar fracture, stable prosthesis ORIF: LCP 3.5

8.4 Proximal ulnar fracture, loose prosthesis Reconstruction: allograft prosthetic composite and reconstruction plate 3.5

8.5 Proximal ulnar fracture, loose prosthesis Reconstruction: allograft prosthetic composite and cerclage wires

9 Wrist cases

9.1 Loose prosthesis, imminent metacarpal fracture Fusion: total wrist fusion with plates

10 Hip cases

10.1 Transverse acetabular fracture, stable hemiarthroplasty ORIF: reconstruction plate and total hip arthroplasty

10.2 Transverse acetabular fracture, loose acetabular cup Reconstruction: two plates and revision arthroplasty, Burch-Schneider antiprotrusio cage, hook plate

10.3 Acetabular fracture, osteolysis, and loose cup Reconstruction: cage, morcelized allograft, cemented new cup

10.4 Proximal femoral fracture, stable prosthesis MIPO: LCP hook plate 4.5/5.0

10.5 Proximal femoral fracture, stable prosthesis ORIF: LCP hook plate 4.5/5.0

10.6 Spiral femoral fracture, stable prosthesis MIPO: lag screw and LCP 4.5/5.0

10.7 Spiral femoral fracture at the tip of a stable prosthesis MIPO: long LCP distal femur, secondary revision with long-stem prosthesis

10.8 Femoral shaft fracture, stable long-stem prosthesis ORIF: locked retrograde intramedullary nail

10.9 Proximal femoral fracture, stable prosthesis ORIF: locked retrograde intramedullary nail

10.10 Refracture/nonunion of the proximal femur, stable prosthesis ORIF: distal femoral locking plate

10.11 Multifragmentary segmental femoral fracture, apparently stable prosthesis ORIF: locked retrograde intramedullary nail with cerclage bands

10.12 Proximal femoral fracture, loose prosthesis Revision: arthroplasty with allograft and cable plate

10.13 Subtrochanteric fracture, loose prosthesis Revision: arthroplasty with cerclage wires and corticocancellous autograft

10.14 Multifragmentary proximal femoral fracture, loose prosthesis Revision: new femoral component, impaction grafting, steel mesh, bridging plate

10.15 Femoral butterfly fracture distal to stable prosthesis MIPO: lag screws and LCP 4.5/5.0 distal femur

10.16 Femoral shaft butterfly fracture distal to stable prosthesis MIPO: distal femur LCP 4.5/5.0 and LAP

10.17 Interprosthetic femoral fracture, stable hip and knee prosthesis ORIF: bridging LCP 4.5/5.0

10.18 Interprosthetic femoral refracture, plate breakage, stable prosthesis ORIF: locked antegrade intramedullary nail

11 Knee cases

11.1 Open patellar fracture dislocation, stable prosthesis ORIF: tension-band fixation

11.2 Pediatric femoral fracture, stable tumor prosthesis ORIF: reverse LISS proximal tibia

11.3 Refracture of a nonunited distal femoral fracture, stable prosthesis ORIF: locked retrograde intramedullary nail

11.4 Distal femoral fracture, loose prosthesis Revision: tumor prosthesis

11.5 Bilateral distal femoral interprosthetic fractures, stable prosthesis MIPO: bilateral LCP 4.5/5.0 distal femur, LAP, secondary medial buttress plate

11.6 Interprosthetic distal femoral fracture, stable prosthesis and hip screw MIPO: polyaxial noncontact plate and secondary addition of a strut graft

11.7 Distal femoral fracture complicated by contralateral intercalary fracture, stable prostheses ORIF: bilateral retrograde intramedullary nails

11.8 Proximal tibial fracture, stable unicondylar prosthesis MIPO: LISS proximal tibia and LCP

11.9 Proximal tibial fracture, stable prosthesis ORIF: buttress plate 4.5 and tension band

11.10 Proximal tibial fracture, stable prosthesis ORIF: LCP 3.5 proximal tibia and LCP 2.0

11.11 Segmental tibial shaft fracture, stable prosthesis MIPO: lateral LISS proximal tibia and medial distal tibia LCP

12 Ankle cases

12.1 Medial malleolar fracture, stable prosthesis Nonoperative treatment: cast

12.2 Distal tibial and fibular stress fracture, stable prosthesis ORIF: LCP 3.5

12.3 Medial malleolar stress fracture, stable prosthesis ORIF: LCP 3.5 and T-LCP 3.5

12.4 Lower-leg fracture, stable ankle prosthesis MIPO: LCP 3.5, metaphyseal LCP 4.5