Periprosthetic Fractures Workup

  • Author: Steven I Rabin, MD; Chief Editor: Jason H Calhoun, MD, FACS   more...
 
Updated: Oct 1, 2010
 

Laboratory Studies

  • 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.
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Diagnostic Procedures

  • 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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Contributor Information and Disclosures
Author

Steven I Rabin, MD  Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

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

Disclosure: Nothing to disclose.

Specialty Editor Board

James F Kellam, MD  Vice-Chair, Department of Orthopedic Surgery, Director of Orthopedic Trauma and Education, Carolinas Medical Center

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

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Samuel Agnew, MD, FACS  Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; 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, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS  Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

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, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

References

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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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