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Review Question - QID 2953

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QID 2953 (Type "2953" in App Search)
A previously healthy 68-year-old woman falls and sustains the fracture seen in Figure A. Her index procedure was approximately 10 years ago. The patient is taken to surgery, and the femoral stem is found to be loose. The acetabular component is found to be well fixed in good position. In addition to using a new poly liner, what other procedure(s) is now indicated in this patient?
  • A

Cemented femoral revision

7%

238/3217

Retention of current hardware and fixation using cerclage wires

1%

27/3217

Open reduction and internal fixation with a locking plate

3%

91/3217

Both uncemented femoral revision and revision of the acetabular shell

2%

58/3217

Uncemented femoral revision bypassing the distal deficiency by two cortices.

87%

2786/3217

  • A

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This is a Vancouver B2 periprosthetic femur fracture as the fracture involves the tip of the stem and the stem is loose. In fracture patterns stabilization with an uncemented extensively porous coated femoral stem is recommended. However, in order to increase the femoral strength similar to the contralateral side, the surgeon must bypass the most distal cortical deficiency by two cortices.

O'Shea et al retrospectively found satisfactory results in patients with Vancouver B2 and B3 periprosthetic femur fractures treated with uncemented extensively porous coated femoral stems with good distal fixation.

Sledge et al described their technique in order to reconstruct the proximal femur as well as use an uncemented femoral stem to achieve good results.

Larson et al found an increase in femoral strength up to 84% of the contralateral side was achieved by bypassing the most distal deficiency by two cortical diameters.

Illustration A summarizes the Vancouver classification of periprosthetic femur fractures.

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