Posted: Dec 16 2020 #(C101678)

Periprosthetic Femur Fracture 63M

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HPI

63-year-old male who had a right THA performed approximately 6 months ago and has had an uneventful postoperative period until recently. Patient reports to the ED after he sustained a ground level fall at home after tripping on a rug. He reports pain isolated to the right hip. He was unable to ambulate after the fall. Denies hitting his head or sustaining other injuries. Prior to this fall he had no pain in his hip or groin and was ambulating without assistive devices.

PMH

HTN, depression, fibromyalgia.

Patient is resting comfortably in bed. No obvious deformity to the hip or leg. TTP about the right thigh proximally. Pain with log roll or any manipulation of the right leg. Previous incisions from THA are well healed without signs of infection or erythema. Motor intact - EHL/FHL/GSC. Sensation intact to all distributions of the foot. DP/PT pulses palpable.

Poll

1 of 8

In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?

1 No - current radiographs are sufficient

2 Yes - additional radiographs (XR)

3 Yes - CT

4 Yes - MRI

5 Yes - XR + CT

6 Yes - XR + MRI

7 Yes - XR + MRI + CT

8 Outside my area of expertise - best if I don't vote

Other

Submit

P: 123674

Would you use a classification system for this injury to guide management?

1 No - a classification system would not help me

2 Yes - Vancouver

3 Yes - AO/OTA

4 Outside my area of expertise - best if I don't vote

Other

Submit

P: 123675

How would you manage this injury?

1 Nonoperative

2 Operative

3 Outside my area of expertise - best if I don't vote

Other

Submit

P: 123676

If you choose Operative management, what procedure would you perform?

1 I would not choose Operative management

2 Open reduction internal fixation (ORIF) only

3 Revision arthroplasty (includes cables, supplementary internal fixation)

4 Outside my area of expertise - best if I don't vote

Other

Submit

P: 123677

If you choose Revision arthroplasty, which component(s) are you going to revise?

1 I would not choose Revision arthroplasty

2 Acetabulum only

3 Femur only

4 Acetabulum + femur

5 Outside my area of expertise - best if I don't vote

Other

Submit

P: 123678

If you choose to revise the femoral component, how would you obtain fixation of the component?

1 I would not revise the femoral component

2 Press-fit

3 Cemented

4 Outside my area of expertise - best if I don't vote

Other

Submit

P: 123887

If you choose to revise the femoral component, what type of implant are you going to use?

1 I would not revise the femoral component

2 Long cylindrical stem

3 Long Wagner (tapered) stem

4 Modular diaphysial fitting stem

5 Other

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 123680

If you choose to revise the femoral component and obtain the construct shown below, what weight bearing status would you assign the patient?

1 I would not choose Revision arthroplasty

2 Non weight bearing (NWB)

3 Touch down weight bearing (TDWB)

4 Weight bearing as tolerated (WBAT)

5 Outside my area of expertise - best if I don't vote

Other

Submit

P: 123681

Intra-procedure P1

Post-procedure P1

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