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THA Periprosthetic Fracture
Posted: Nov 14 2022 #(C102104)
A

THA Periprosthetic Fracture in 92M

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THA Periprosthetic Fracture in 92M

HPI

A 92-year-old male sustained a ground-level fall at home and was subsequently unable to bear weight on his left leg. The patient and family deny loss of consciousness or other acute injuries from this fall. The patient had an uneventful Left THA with a fully coated Corail implant done in 2006. The patient uses a walker at baseline for ambulation.

PMH

PMH: CAD s/p CABG PSH: L THA 2006

PE

A focused physical exam reveals the left leg in external rotation. There is swelling of the thigh. The patient is unable to perform a straight leg raise and has pain with log roll of the leg. Distally the patient is neurovascularly intact.

Poll
1 of 1
1. In addition to standard AP and LAT Xrays of the femur, would you obtain any further imaging to guide your treatment?
No - AP and LAT Xrays are sufficient
44%
426/947
    • Yes - additional Xrays (aXR) (includes post reduction, contralateral, other)
    5%
    53/947
    • Yes - CT (includes CTA, 3D recon)
    40%
    383/947
    • Yes - MRI (includes MRA, MARS)
    0%
    6/947
    • Yes - aXR + CT
    5%
    56/947
    • Yes - aXR + MRI
    0%
    1/947
    • Yes - CT + MRI
    0%
    2/947
    • Yes - aXR + MRI + CT
    0%
    4/947
    • Outside my area of expertise - best if I don't vote
    1%
    16/947
    • PROCEDURE #1 DOP: 7/29/2022

    ORIF B1/B2 PERIPROSTHETIC FRACTURE OF LEFT THA WITH POTTED DISTAL STEM

    Intra-procedure P1
    icon
    OUTCOMES
    Post-procedure P1
    11 weeks after
    Post-procedure P1
    POLL#
    Surgeon's Choices
    1
    In addition to standard AP and LAT Xrays of the femur, would you obtain any further imaging to guide your treatment?
    Yes - CT (includes CTA, 3D recon)
    2
    Based on the injury xrays provided, do you think the femoral component is stable/fixed or loose?
    Stable/Fixed
    3
    If you choose to use the Vancouver Classification System, How would you classify this fx?
    B1
    4
    If you choose Operative Management, what treatment would you choose?
    Open reduction internal fixation (ORIF) Alone
    5
    If you choose Revision Arthroplasty, which component(s) are you going to revise?
    Femur Alone
    6
    If you choose to revise the Femoral component, how would you obtain fixation of the component?
    Press-fit
    7
    If you choose to revise the Femoral component with a Press-fit stem, what type of implant are you going to use?
    Modular diaphysial fitting stem
    8
    If you choose ORIF Alone, what fixation construct would you use?
    Plate(s), includes plate screws (Plates) Alone
    9
    If you choose ORIF Alone with Plate(s) + Cable(s), what positioning and surgical approach would you use?
    Lateral, subvastus approach to femur
    10
    If you choose ORIF Alone with Plate(s) + Cable(s), how would you achieve proximal fixation?
    Bicortical non-locking screw(s) +/- cerclage Cable(s)
    11
    If you choose ORIF Alone with Plate(s) + Cable(s), and obtained the construct shown, what initial post-operative weight-bearing status would you assign the patient?
    Weight-bearing as tolerated (WBAT)
    12
    If you choose ORIF Alone with Plate(s) + Cable(s) and obtained the construct shown, when would you allow for FULL weight-bearing?
    < 2 weeks
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