假体周围骨折的分型与治疗方案汇编.ppt

Long Fixation Span Conclusions Vancouver Classification Helpful in Treatment Decisions Indirect Reduction If Plate Used Cables and Onlay Grafts Helpful Think LONG on Plates and Nails Always Think of the Next Operation Thank You * * * * * * * * * * * * * * * * * * Periprosthetic FracturesClassification and Treatment Increasing Numbers More Arthroplasties More Internal Fixation Osteoporotic Fractures More Independent Elderly More Revisions Incidence Increasing Between 1987 – 2003 Incidence 0.14% Between 2004 – 2007 Incidence 0.78% ????????? Earlier Mobilization Smaller Incisions Proximally Coated Stems ????????? Berry et. al. 2007 “…it is becoming a little bit of a mini epidemic.” D. Berry, MD Intraoperative Fracture Cemented Hip Stem 1% incidence of fracture Cementless Hip Stem 3% - 20% incidence of fracture Revision arthroplasty 6.3% with cemented stem 17.6% with cementless stem Intraoperative FractureRisk Factors Cementless Implant Revision Surgery Decreased Bone Strength Osteoporosis Ra Deformity Surrounding Implant Intraoperative FractureTreatment Fracture Proximal To Lesser Trochanter Cables Collared Implant Perforations Longer Stem-bypass Perforation By 2 1/2 Canal Diameters +/- Supplemental Bone Grafting Periprosthetic FracturesRisk Factors Decreased bone strength Perforations Loose stem Osteolysis Stress risers Screw holes Treatment Goals United Fracture Anatomic Alignment Stable Prosthesis Early Mobilization Return To Previous Function Treatment Many Option / Permutations Non-operative Revision Arthroplasty And / Or ORIF And / Or Strut Grafting No Clear Consensus Each Case Must Be Individualized Critical Factors Stability Of The Prosthesis Location Of The Fracture Relative To Prosthesis Quality Of Bone Patient Age Medical Condition Baseline Status Vancouver Classification(Fractures About THA Stems) Considerations Location Of The Fracture Implant Stability Bone Quality Vancouver Classification Type determined by location Type A Trochanteric r