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Periprosthetic Fractures Workup

  • Author: Steven I Rabin, MD; Chief Editor: Jason H Calhoun, MD, FACS  more...
 
Updated: May 13, 2014
 

Laboratory Studies

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  • No special laboratory studies are required for most periprosthetic fractures. A sedimentation rate and CBC count with differential is useful if infection is suspected.
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Imaging Studies

Radiographs of the entire bone are required to assess the condition of the joint above and below the fracture, condition of the implant, presence of deformity or lesions that may influence surgical options, and axial alignment of the bone. Two views perpendicular to each other, most often an anteroposterior (AP) and lateral view of the bone, are always required.

CT scan and MRI have limited use because of scatter artifact caused by the metallic implant. Bone scans are not specific.

Careful attention to the condition of the cement mantle (for cemented prostheses) is important to determine the stability of the prosthesis.[5]

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Diagnostic Procedures

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  • Aspiration of a failed joint replacement may help if infection is suspected.
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Histologic Findings

Biopsy at the time of surgery is indicated if pathologic fracture or infection is suspected.

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Staging

There are different classification systems for different fracture sites. For periprosthetic fractures around a total hip replacement, the most common classification is the Vancouver classification of Duncan and Masri. Type A fractures are fractures of the greater or lesser trochanters. Type B fractures involve the femoral diaphysis and/or metaphysis around the femoral stem and are subdivided into 3 types. In type B1 fractures, the stem is stable, B2 fractures are associated with a loose stem, and B3 fractures are associated with a loose stem and significant bone loss. Type C fractures are well distal to the tip of the femoral stem.

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Contributor Information and Disclosures
Author

Steven I Rabin, MD Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Orthopedic Surgery, Podiatry, Rheumatology, Sports Medicine, and Pain Management, Dreyer Medical Clinic; Chairman, Department of Surgery, Provena Mercy Medical Center

Steven I Rabin, MD is a member of the following medical societies: AO Foundation, American Academy of Orthopaedic Surgeons, American Fracture Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS Department Chief, Musculoskeletal Sciences, Spectrum Health Medical Group

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Michigan State Medical Society, Missouri State Medical Association, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, Texas Orthopaedic Association, Musculoskeletal Infection Society

Disclosure: Nothing to disclose.

Additional Contributors

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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Distal femur fracture during hip arthroplasty.
Failed fixation caused by fracture through screw holes.
Fracture around a loose prosthesis treated with replacement.
Fracture at the end of an implant treated with replacement.
Fracture around a stable prosthesis treated with flexible rods.
Fracture around a plate implant treated with rigid rod.
Fracture around a stable prosthesis treated with rigid rod.
Fracture around a stable prosthesis treated with standard plate.
Fracture around a stable rod implant treated with plate.
Fracture around a plate treated with a rod (pathologic).
Open reduction internal fixation with 2 "combi" fixed-angle locking screw plates (anterior and lateral placement to help control both anterolateral and mediolateral forces).
Fracture around a stable implant treated with a less invasive stabilization system (LISS) plate.
 
 
 
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