Journal of Musculoskeletal Trauma

Mortality-Related Risk Factors in Total Hip Arthroplasty for Femoral Neck Fractures in Elderly Patients: Jae Sung Suh, Hyung Gon Ryu, Young Ju Roh, Dae Won Shin; J Korean Fract Soc 2022;35(2):51-56. Published online April 30, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.2.51

Abstract PDF: Purpose
Total hip arthroplasty (THA) using dual mobility components (DMC) is a reasonable surgical option for displaced femoral neck fractures in elderly patients, resulting in lower dislocation rates and improved stability. The purpose of this study was to investigate the clinical outcomes and risk factors responsible for mortality in elderly patients who were diagnosed with a displaced femoral neck fracture and had undergone DMC-THA.
Materials and Methods
Out of 147 cases of THA from December 2018 to June 2020, a total of 79 cases were enrolled in this study, with the following characteristics: (1) Garden stage III or IV, (2) over 75 years of age, and (3) over 1 year of follow-up. All the patients received DMC-THA surgery using the anterolateral approach.
Results
The mean follow-up period was 15.0±8.43 months and a total of one dislocation case was observed. The mortality rate was 17.7% (14/79), and it was especially higher in patients with a past medical history of malignancy (odds ratio [OR]=7.18, p=0.03) or a cognitive disorder such as dementia (OR=5.48, p=0.03). Preoperative low initial hemoglobin levels (OR=0.65, p=0.04) and low UCLA (Uni-versity of California at Los Angeles) score (OR=0.47, p=0.02) were also associated with mortality.
Conclusion
When considering THA as a treatment approach in elderly patients with a displaced femoral neck fracture, a high mortality rate is expected in patients with low preoperative hemoglobin levels or a history of malignancy or cognitive disorders. Hence, thorough monitoring and management should be undertaken before and after surgery.

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Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty: Jung Hoon Choi, Jong Hyuk Jeon, Kyung Jae Lee; J Korean Fract Soc 2020;33(1):43-51. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.43

Abstract PDF: Although the incidence of postoperative periprosthetic femoral fractures after hip arthroplasty is expected to increase, these complex fractures are still challenging complications. To obtain optimal results for these fractures, thorough clinical and radiographic evaluation, precise classification, and understanding of modern management principles are mandatory. The Vancouver classification system is a simple, effective, and reproducible method for planning proper treatments of these injuries. The fractures associated with a stable femoral stem can be effectively treated with osteosynthesis, though periprosthetic femoral fractures associated with a loose stem require revision arthroplasty. We describe here the principles of proper treatment for the patients with periprosthetic femoral fractures as well as how to avoid complications.

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The Clinical and Radiological Results of Vancouver Type B1 and C Periprosthetic Fractures: Bo Ram Na, Taek Rim Yoon, Kyung Soon Park; J Korean Fract Soc 2016;29(1):26-33. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.26

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the clinical and radiologic results of plate fixation in the Vancouver B1 and C periprosthetic femoral fracture (PFF).
MATERIALS AND METHODS
Twenty patients who had sustained a Vancouver type B1 and C periprosthetic fracture after hip arthroplasty (years 2002-2012) were identified. The mean age was 66.0 years (range, 43-85 years) and the mean follow-up duration of the group was 38 months (range, 12-102 months). The dynamic compression plate (DCP) group included 12 patients and the locking compression plate (LCP) group included eight patients. Harris hip score (HHS) and walking ability, knee joint range of motion (ROM) were compared before injury and last follow-up. Fracture union rate and period were compared.
RESULTS
The mean HHS score was 90.7 (64-96). There was no statistical difference between the two groups. At the last follow-up, knee joint ROM was 103.3degrees (105degrees-140degrees) in the DCP group and 118.4degrees (110degrees-140degrees) in the LCP group, showing good results in the LCP group (p=0.043). No significant difference in the fracture union rate and union periods was observed between the two groups.
CONCLUSION
A better result for the postoperative knee flexion exercise capacity was observed in the LCP group. Use of LCP plate fixation is a good option in management of Vancouver classification B1 and C PFF.

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The Problems of Plate Fixation in the Management of Periprosthetic Femoral Fracture: Myung Sik Park, Byung Wan Choi, Hyun kyung Bae, Jong Hyuk Park; J Korean Soc Fract 2003;16(2):148-154. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.148

Abstract PDF: PURPOSE
The purpose was to evaluate the postoperative periprosthetic femur fracture of hip arthroplasty and relative problems of management using plate fixation. MATERIAL AND METHOD: We reviewed 37 cases of femoral fractures out of 1,270 (1,183 primary hips and 97 revision hips) hips which received hip arthroplasty during the observation period (1985~1998). We classified them according to the stability and the location of the fractures related to the stem tip: Proximal (I), middle (around stem) (II) and distal (III). Then we subclassified the fractures as cortical perforation or a fissure, undisplaced (A), displaced (B) and unstable prosthesis (C). we managed periprosthetic fracture with splint applied or cerclage proximal fracture (type I), plate fixation and bone grafts in the stem tip (type II) or distal fracture (type III). In unstable fractures, we revised them with long fluted stems.
RESULT
The average union time is 3.1 months (range, 2~6.2 months). After management of fracture with plate showed 5 complications, two nonunion and three refractures. The causes of nonunion are early weight bearing and a too short plate. The causes of refracture are screw fixation and empty hole just distal to stem tip. The other caused by the roles of stress riser in proximal screw of blade plate in management of supracondylar fracture.
CONCLUSION
We recommend the use of cerclage band system or fixed in a more proximal site in long plate and bone graft. In unstable prosthesis, we had taken a best results after revised with distal fluted stem, in which we don't need further distal stability like a additional cerclage or locking screw and additional bone graft.

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Total Hip Arthroplasty Following Acetabular Fracture: Myung Chul Yoo, Yoon Je Cho, Kang Il Kim, Young Soo Chun, Dong Oh Ko, Jin Woong Yi; J Korean Soc Fract 2003;16(2):121-127. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.121

Abstract PDF: PURPOSE
We evaluated the results of secondary total hip arthroplasty (THA) after acetabular fracture. MATERIAL & METHODS: Twenty cases of THA were performed to treat acetabular fracture as a secondary treatment after conservative management (6 cases) or internal fixation (14 cases). The mean follow up period was 5 years 2 months. The cause of secondary THA was post traumatic arthritis in 15 hips and osteonecrosis of the femoral head in 5. Cementless acetabular cup was used in 18 cases and cemented in 2 cases. Cementless femoral component was used in 18 cases and cemented in 2 cases. Serial Harris hip score (HHS), pain, limb length discrepancy and radiographs were evaluated.
RESULTS
HHS improved from 57 points to 91 points. Osteolysis in the acetabular component occurred in 2 cases and 5 cases in the femoral component. Loosening occurred in 2 cases of cemented acetabular components and 1 case in the femoral component. In this study, 3 cases (15%) required revision of the acetabular component and 2 cases (10%) of the femoral component.
CONCLUSION
The clinical results of THA after acetabular fracture was inferior to that of conventional arthroplasty. The secure cementless acetabular fixation with proper bone grafting is mandatory to improve the survival of acetabular component.

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Treatment of bone cystic change with femoral head fracture in Neurofibromatosis patient: Jae Do Kang, Hyung Chun Kim, Chi Wook Kyoung, Hyun Chul Seo; J Korean Soc Fract 2002;15(3):427-431. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.427

Abstract PDF: Cystic change on femoral head and neck in neurofbromatosis patient is rare case. Scoliosis is the most common bony lesion. Others are appeared at changes of out feature in long bone shaft. Bone cyst with bone fracture are treated with non operation or external fixation, osteotomy, curettage, partial and complete excision of cyst capsule, steroid injection therapy, bone graft, internal fixation, arthroplasty. We have experienced a case of bone cystic change on femoral head and neck with femoral head fracture and acetabular lesion in neurofibromatosis patient treated with total hip arthroplasty who was acceptable result.

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Lateral Insufficiency Fracture of the Femur caused by Osteopenia & Varus angulation after Hip Arthroplasty: Case Report: Myung Sik Park, Yong Min Kim; J Korean Soc Fract 2001;14(3):358-363. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.358

Abstract PDF: Lateral femoral insufficiency fracture in total hip arthroplasty occur due to osteopenia and varus positioning of the femoral component. The presentation of these fractures usually involves the insidious onset of unexplained thigh or groin pain. The insufficiency fracture generally occur at the level of the femoral stem tip on the lateral cortex of the femur. Recommended treatment involves revision to a long stem femoral component. This is the first report of lateral femoral insufficiency fracture simply regarded as periprosthetic fracture of the femur.

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Fractures of the Femur associated with the Hip Arthroplasty: Sung Kwan Hwang, Young Sang Lee, Jin Soo Park; J Korean Soc Fract 1999;12(4):837-843. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.837

Abstract PDF: Periprosthetic fractures as a complication of hip arthroplasty are uncommon. However, the incidence has been increafed recently especially in cementless or press-fit arthroplasties. The need to achieve a tight fit of the prosthesis in the bone when using cementless component has led to increased risk of periprosthetic fractures. We have experienced periprosthetic fractures occurred in 52 cases(51 patients) among 814 hip arthroplastic from January 1990 to December 1997. Among the 52 cases of periprosthetic fractures, 5 cases were occurred in cemented femoral stem(5 cases among the total 236 cases of cemented femoral stem : 2.1%), and 47 cases were occurred in the cementless type of femoral stem(47 cases among the total 578 cases of cementless type of femoral stem : 8.1%). There were 43 cases of intraoperative fracture and the rest was occurred postoperatively. According to the Johannson classification, type I fractures were 28 cases, type II fractures were 20 cases, and type III fractures were 4 cases. In postoperative periprosthetic fractures, according to the Vancouver classification, type A fracture was 1 case, typeB 1 fractures were 4 cases, typeB2 fractures were 2 cases, and type C fractures were 2 cases. The accurate preoperative templating and prophylactic managemnet of the risk factors are important for reducing the incidence of periprosthetic fractures.

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Treatment of Intertrochanteric Fractures of Femur in Elderly Patients over 65 Years Old: Yoo Seong Seo, Hyung Suk Choi, Sang Gi Kim, Byung Joon Shin, Soo Kyun Rah, Chang Uk Choi; J Korean Soc Fract 1995;8(1):54-60. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.54

Abstract PDF: The ipsilateral femur fracture after hip arthroplasty is rare, but serious complication. And its treatment is difficult and controversial. We experienced 6 patients who had the hip arthroplasty complicated by an ipsilateral femur fracture in postoperative period at the Department of Orthopaedic Surgery, Soonchunhyang Univesity from February 1990 to December 1993. The Type 1 fracture was 1 case, and 2 Type IV-A, and 1 Type IV-3, and 2 Type V according to AAOS classification. Bony union and satisfactory clinical results were achieved in all 6 cases.

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Early experience with Dall-Miles cable grip system at femur fracture after hip arthroplasty: 3 case report: Jin Hwan Kim, Suk Kyu Joo, Byung Jik Kim; J Korean Soc Fract 1994;7(2):465-470. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.465

Abstract PDF: The femur fracture after hip arthroplasty is rare, but serious complication. So, its treatment is difficult and controversial. Nonunion and loosening of hip arthroplasty are common at this problem and badly affected to hip joint function. We have experienced 3 cases with Dall-Miles cable grip system at femur fracture after hip arthroplasty. Dall-Miles cable grip system provides rigid fixation including greater trochanter. The results was good at early experience and necessary to long term follow up.

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