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Handbook of Fractures > Periprosthetic Fractures > Flashcards

Periprosthetic Fractures Flashcards

1
Q

incidence of intraoperative femoral shaft fractures in total hip arthroplasty

A

0.8% to 2.3%

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2
Q

incidence of postoperative femoral shaft fractures in total hip arthroplasty

A

0.1%

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3
Q

do femoral shaft fractures occur more frequently with noncemented or cemented components

A

noncemented

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4
Q

risk factors for femoral shaft fractures in total hip arthroplasty (8)

A

osteopenia, rheumatoid arthritis, tha following failed orif, stress risers secondary to cortical defects, revision surgery, inadequate implant site preparation, pericapsular pathology (inadequate releases), loose components

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5
Q

what percentage of femoral shaft fractures in total hip arthroplasty are caused by loose femoral components

A

33%

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6
Q

surgical considerations to avoid periprosthetic fracture during revision surgery (6)

A

longer-stem prosthesis (spanning twice the bone diameter beyond the defect), bone grafting, strut allograft or plate support, cortical windows in anterolateral location on femur in line with neutral bending axis, leave cortical windows <30% of bone diameter, choose correct starting point for reaming and broaching

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7
Q

johansson periprosthetic femoral shaft fracture type 1 (location and stem status)

A

fracture proximal to the prosthetic tip with the stem remaining in the medullary canal

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8
Q

johansson periprosthetic femoral shaft fracture type 2 (location and stem status)

A

fracture extending beyond the distal stem with dislodgement of the stem from the canal

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9
Q

johansson periprosthetic femoral shaft fracture type 3 (location)

A

fracture entirely distal to the tip of the prosthesis

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10
Q

coke and newman (modification of bethea et al.) periprosthetic femoral shaft fracture type 1

A

explosion type with comminution around the stem; prosthesis always loose and fracture inherently unstable

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11
Q

coke and newman (modification of bethea et al.) periprosthetic femoral shaft fracture type 2

A

oblique fracture around the stem; fracture pattern stable, but prosthetic loosening usually present

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12
Q

coke and newman (modification of bethea et al.) periprosthetic femoral shaft fracture type 3

A

transverse fracture at the distal tip of the stem; fracture unstable, but prosthetic fixation usually unaffected

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13
Q

coke and newman (modification of bethea et al.) periprosthetic femoral shaft fracture type 4

A

fracture entirely distal to the prosthesis; fracture unstable, but prosthetic fixation usually unaffected

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14
Q

aaos classification periprosthetic femoral shaft fracture level 1

A

proximal femur distally to the lower extent of lesser trochanter

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15
Q

aaos classification periprosthetic femoral shaft fracture level 2

A

10 cm of the femur distal to level 1

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16
Q

aaos classification periprosthetic femoral shaft fracture level 3

A

covers remainder of femur distal to level 2

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17
Q

aaos classification periprosthetic femoral shaft fracture type 1

A

fracture proximal to the intertrochanteric line that usually occurs during dislocation of the hip

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18
Q

aaos classification periprosthetic femoral shaft fracture type 2

A

vertical or spiral split that does not extend past the lower extent of the lesser trochanter

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19
Q

aaos classification periprosthetic femoral shaft fracture type 3

A

vertical or spiral split that extends past the lower extent of the lesser trochanter but not beyond level 2, usually at the junction of the middle and distal thirds of the femoral stem

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20
Q

aaos classification periprosthetic femoral shaft fracture type 4

A

fractures that traverse or lie within the area of the femoral stem in level 3, with type 4a being a spiral fracture around the tip and type 4v being a simple transverse or short oblique fracture

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21
Q

aaos classification periprosthetic femoral shaft fracture type 5

A

severely comminuted fractures around the stem in level 3

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22
Q

aaos classification periprosthetic femoral shaft fracture type 6

A

fractures distal to the stem tip, also in level 3

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23
Q

vancouver classification periprosthetic femoral shaft fracture type a

A

fracture in the trochanteric region

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24
Q

vancouver classification periprosthetic femoral shaft fracture type ag

A

greater trochanter region

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25
Q

vancouver classification periprosthetic femoral shaft fracture type al

A

lesser trochanteric region

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26
Q

vancouver classification periprosthetic femoral shaft fracture type b

A

fracture around or just distal to the stem

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27
Q

vancouver classification periprosthetic femoral shaft fracture type b1

A

stable prosthesis

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28
Q

vancouver classification periprosthetic femoral shaft fracture type b2

A

unstable prosthesis

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29
Q

vancouver classification periprosthetic femoral shaft fracture type b3

A

unstable prosthesis plus inadequate bone stock

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30
Q

vancouver classification periprosthetic femoral shaft fracture type c

A

well below the stem

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31
Q

treatment-dependent factors of periprosthetic femoral shaft fractures (5)

A

location, prosthesis stability, bone stock, age and medical condition of patient, accurate reduction and secure fixation

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32
Q

treatment options for periprosthetic femoral shaft fractures (3)

A

nonoperative treatment, orif, revision plus orif

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33
Q

nonoperative treatment for periprosthetic femoral shaft fractures (4)

A

limited weight bearing, brace, cast, or traction

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34
Q

orif options for periprosthetic femoral shaft fractures (2+/-1)

A

plate/screws or cable +/- strut allograft

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35
Q

choice of uncemented implants used in the treatment of vancouver type 2b periprosthetic femoral shaft fractures (3)

A

extensive coated long-stem curved prosthesis, flute long-stem prosthesis, modular implants

36
Q

treatment of vancouver type c periprosthetic femoral shaft fractures (2+/-1)

A

treated independently of the arthroplasty (plate/screws and/or cables with or without strut allograft)

37
Q

treatment of nondisplaced periprosthetic acetabular fractures (1)

A

limited weight-bearing (crutches)

38
Q

complication associated with nondisplaced periprosthetic acetabular fractures (1)

A

late loosening of the acetabular component requiring revision

39
Q

risk factor for intraoperative periprosthetic acetabular fractures

A

significant underreaming prior to press fit cup

40
Q

complications associated with late periprosthetic acetabular fractures (2)

A

osteolysis or stress shielding

41
Q

what must be assessed for in all periprosthetic acetabular fractures (1)

A

pelvic discontinuity

42
Q

treatment of displaced periprosthetic acetabular fractures (2)

A

orif with component revision

43
Q

incidence of periprosthetic supracondylar femur fractures in total knee arthroplasty in primary tka and revisions

A

0.6% to 2.8% in primaries, up to 6.3% in revisions

44
Q

risk factors for periprosthetic supracondylar femur fractures in total knee arthroplasty (4)

A

osteoporosis, preexisting neurologic disease, knee stiffness/arthrofibrosis, notching of the anterior cortex

45
Q

anterior notching in tka of 3 mm reduces torsional strength by what percentage

A

29%

46
Q

is there a correlation between notching and supracondylar fractures in the absence of significant osteopenia

A

no

47
Q

what can be done if notching >3mm is noted intraoperatively

A

consider stemmed implant

48
Q

neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 1

A

minimally displaced supracondylar fracture

49
Q

neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 2

A

displaced supracondylar fracture

50
Q

neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 3

A

comminuted supracondylar fracture

51
Q

neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 4

A

fracture at the type of the prosthetic femoral stem of fracture of the diaphysis above the prosthesis

52
Q

neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 5

A

any fracture of the tibia

53
Q

lewis and rorabeck classification of periprosthetic femur fractures about total knees type 1

A

nondisplaced fracture, and the bone-prosthesis interface remains intact

54
Q

lewis and rorabeck classification of periprosthetic femur fractures about total knees type 2

A

interface remains intact, but the fracture is displaced

55
Q

lewis and rorabeck classification of periprosthetic femur fractures about total knees type 3

A

patient has a loose or failing prosthesis in the presence of either a displaced or a nondisplaced fracture

56
Q

treatment principles of periprosthetic supracondylar femur fractures (4)

A

anatomic/mechanical alignment critical, nondisplaced fractures may be treated nonoperatively, orif indicated if alignment unacceptable by closed means and if bone stock is adequate for fixation devices, immediate prosthetic revision is indicated in selected cases

57
Q

nonoperative treatment of periprosthetic supracondylar femur fracture (cast type and length of treatment)

A

long leg casting or cast bracing for 4 to 8 weeks for minimally displaced fractures

58
Q

options for orif stabilization of periprosthetic supracondylar femur fractures (6)

A

blade plate, dynamic condylar screw, dynamic compression plate, condylar buttress plate, locked plate, retrograde intramedullary nailing

59
Q

when can primary revision with a stemmed implant be considered for the treatment of periprosthetic supracondylar femur fracture (2)

A

involvement of the bone-implant interface, loose prosthesis

60
Q

treatment of periprosthetic supracondylar femur fractures around the diaphysis or tip of a femoral component (3)

A

cortical strut grafts and cerclage wiring, dynamic compression plate, locked plate

61
Q

acceptable alignment guidelines for periprosthetic supracondylar femur fractures (4)

A

angulation <1cm shortening

62
Q

periprosthetic tibial fracture risk factors (6)

A

significant trauma, tibial component malalignment associated with increased medial plateau stress fractures, revision surgery with press-fit stems to bypass a defect, loose components and osteolysis, more common with increase in unicompartmental knee replacement, pin site placement

63
Q

three factors forming the basis of felix classification of periprosthetic tibial fractures

A

location, stability of implant, whether the fracture occurred intraoperatively or postoperatively

64
Q

felix classification periprosthetic tibial fracture type 1

A

occur in the tibial plateau

65
Q

felix classification periprosthetic tibial fracture type 2

A

adjacent to the stem

66
Q

felix classification periprosthetic tibial fracture type 3

A

distal to the prosthesis

67
Q

felix classification periprosthetic tibial fracture type 4

A

involve the tubercle

68
Q

felix classification periprosthetic tibial fracture subtype a

A

well-fixed implant

69
Q

felix classification periprosthetic tibial fracture subtype b

A

loose implant

70
Q

felix classification periprosthetic tibial fracture subtype c

A

fractures are intraoperative

71
Q

preferred treatment of periprosthetic tibial fractures

A

closed reduction and cast immobilization

72
Q

indications for orif of periprosthetic tibial fractures (1)

A

failed closed reduction and cast immobilization

73
Q

treatment of type 1 periprosthetic tibial fractures (1)

A

revision of tibial component

74
Q

periprosthetic patella fractures postoperative incidence

A

0.3% to 5.4%

75
Q

periprosthetic patella fractures risk factors (6)

A

large central peg component, excessive resection of patella during prosthetic implantation, lateral release with devascularization of the patella, malalignment, thermal necrosis (secondary to methylmethacrylate), excessive femoral component fixation

76
Q

golberg classification for periprosthetic patella fractures type 1

A

fractures not involving cement/implant composite or quadriceps mechanism

77
Q

golberg classification for periprosthetic patella fractures type 2

A

fractures involving cement/implant composite and/or quadriceps mechanism

78
Q

golberg classification for periprosthetic patella fractures type 3a

A

inferior pole fractures with patellar ligament disruption

79
Q

golberg classification for periprosthetic patella fractures type 3b

A

inferior pole fractures without patellar ligament disruption

80
Q

golberg classification for periprosthetic patella fractures type 4

A

fracture-dislocations

81
Q

nonoperative treatment indications for periprosthetic patella fractures (3)

A

fractures without component loosening, extensor mechanism rupture, or malalignment of implant (type 1 or 3b)

82
Q

nonoperative treatment for periprosthetic patella fractures

A

knee immobilizer for 4 to 6 weeks, partial weight bearing on crutches

83
Q

operative treatment indications for periprosthetic patella fractures (3)

A

disruption of extensor mechanism, patellar dislocation, prosthetic loosening (types 2, 3a, 4)

84
Q

operative treatment options for periprosthetic patella fractures (3)

A

orif with revision of prosthetic patella, fragment excision, patellectomy

85
Q

surgical considerations for operative treatment of periprosthetic patella fractures (4)

A

adequate medial arthrotomy, adequate lateral release, preservation of superior lateral geniculate artery, preservation of patellar fat pad

Handbook of Fractures (6 decks)

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