Review Question - QID 4577

This fracture pattern is typically referred to as an interprosthetic fracture; this is increasing in incidence due to increasing numbers of patients with ipsilateral hip and knee arthroplasty.

The first reference by Ricci et al reviewed 50 Vancouver B1 fractures treated with a lateral plate without allograft. They reported 100% union rate at a mean of 12 weeks and only one deep infection. Nearly 75% of patients were able to return to their baseline ambulatory status.

The second reference by Ricci et al reviewed 59 patients with periprosthetic femur fractures (THA or TKA) treated with ORIF without bone grafting. They report 58/59 patients healed after the index procedure and 49/59 were able to return to their baseline functional level.

The reference by Fulkerson et al reported on 24 patients who underwent LISS plate fixation of periprosthetic femur fractures around well-fixed THA or TKA. They reported union in 21/24 at a mean of 6.2 months, with only one failure of fixation. They note that percutaneous fixation is effective although technically demanding.

Figure A shows an interprosthetic femur fracture between well-fixed hip and knee arthroplasties.

Incorrect Answers:
Answer 1: Nonoperative management is not indicated for this fracture pattern in this patient.
Answer 3: Use of a cortical allograft strut without plate support is not indicated.
Answer 4: Revision of the femoral stem is not indicated in this case because the stem appears completely stable on the provided radiograph.
Answer 5: Total femoral replacement is not indicated as a primary procedure for this injury pattern.