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Review Question - QID 7687

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QID 7687 (Type "7687" in App Search)
An 82-year-old woman underwent cemented right total hip arthroplasty approximately 15 years ago. She fell and sustained the injury shown in Figure 99. What is the most appropriate management for this injury?
  • A

Open reduction and internal fixation of the femur with a plate, screws, and cerclage wires

17%

101/605

Open reduction and internal fixation of the femur with a plate, screws, cerclage wires, and cortical strut allograft

5%

29/605

Revision of the acetabular component with open reduction and internal fixation of the femur with a plate, screws, and cortical strut allograft

21%

126/605

Revision of the acetabular and femoral components

49%

294/605

Revision of the femoral component with a long cemented stem

7%

45/605

  • A

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The radiograph demonstrates a Vancouver type b-3 periprosthetic femur fracture with a loose femoral stem and acetabular component. Open reduction and internal fixation would not be appropriate in the setting of loose components. The femur has circumferential radiolucent lines in the bone-cement interface and the bone quality of the proximal femur is poor. In addition, the cemented acetabular component is loose and has migrated proximally. Appropriate treatment includes acetabular revision and femoral revision. Options for femoral revision include an allograft-prosthesis complex, extended osteotomy with cables, or a proximal femoral replacement.

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