假体周围骨折的分型与治疗方案.pptx

PeriprostheticFractures

ClassificationandTreatment

IncreasingNumbersMoreArthroplastiesMoreInternalFixationOsteoporoticFracturesMoreIndependentElderlyMoreRevisions

IncidenceIncreasingBetween1987–2023Incidence0.14%Between2023–2023Incidence0.78%?????????EarlierMobilizationSmallerIncisionsProximallyCoatedStems?????????Berryet.al.2023“…itisbecomingalittlebitofaminiepidemic.”D.Berry,MD

IntraoperativeFractureCementedHipStem1%incidenceoffractureCementlessHipStem3%-20%incidenceoffractureRevisionarthroplasty6.3%withcementedstem17.6%withcementlessstem

IntraoperativeFracture

RiskFactorsCementlessImplantRevisionSurgeryDecreasedBoneStrengthOsteoporosisRaDeformitySurroundingImplant

IntraoperativeFracture

TreatmentFractureProximalToLesserTrochanterCablesCollaredImplantPerforationsLongerStem-bypassPerforationBy21/2CanalDiameters+/-SupplementalBoneGrafting

PeriprostheticFractures

RiskFactorsDecreasedbonestrengthPerforationsLoosestemOsteolysisStressrisersScrewholes

TreatmentGoalsUnitedFractureAnatomicAlignmentStableProsthesisEarlyMobilizationReturnToPreviousFunction

TreatmentManyOption/PermutationsNon-operativeRevisionArthroplastyAnd/OrORIFAnd/OrStrutGraftingNoClearConsensusEachCaseMustBeIndividualized

CriticalFactorsStabilityOfTheProsthesisLocationOfTheFractureRelativeToProsthesisQualityOfBonePatientAgeMedicalConditionBaselineStatus

VancouverClassification

(FracturesAboutTHAStems)ConsiderationsLocationOfTheFractureImplantStabilityBoneQuality

VancouverClassificationTypedeterminedbylocationTypeATrochantericregionTypeBAbouttipofstemTypeCDistaltotipofstem

TypeB(AtTip)

SubClassificationTypeB1ImplantIsStableTypeB2ImplantIsLooseSatisfactoryBoneTypeB3ImplantIsLooseInadequateBoneStock

TreatmentTypeA-TrochantericRegionUsuallyStableProtectedWBORIFCablesPlatePlate+Cables

VancouverTypeC

TreatmentORIFAvoidStressR