Displaced Femur Fracture Below a Total Hip

Peri- Prosthetic Fracture

Fractures of the femur that occur below a total hip implant or above a total knee implant are referred to as a peri-prosthetic fractures. These fractures are technically very difficult to repair adequately because of two confounding in factors:  poor bone quality and the logistical restrictions of pre-existing total joint implants. The first step in ascertaining the appropriate treatment of such a fracture is to determine whether the prosthetic implant is well fixed to the bone or whether the fracture  has loosened implant.

In cases where the implant is well fixed to the bone treatment is largely aimed at restoring the alignment of the femur and securing it firmly with a plate. The area where the plate and implant overlap is generally fixed with cables and short screws well the portion of the plate not adjacent to the implant is fixed to the bone with larger screws. Restoration of adequate stability will result in rapid healing of the femur. One of the main complications with this type of surgery is an inability to get good fixation of the plate to the bone overlying the prosthetic implant. There are number of different strategies which allow me to repair these fractures without revising the total hip her total knee implant. Most notably the use of a locked plate, in which the screws actually thread into the plate, has greatly improved my ability to care for these fractures. Most patients remain in the hospital for 5-7 days and recovery is fairly gradual with normal walking at about 3-4 months after repair.

Femur Fracture repaired with a Plate, Cables and Screws

In cases where the implant is loose and because of the fracture, revision of the implant will need to be performed otherwise the artificial joint would not function properly. In these cases additional planning is required to try and matched the original implant that was placed. In some cases this will delay surgery day or 2 until we are able to get the records to determine what type of and size of implant has been placed previously. Surgery goals are two fold: Revision of the loosened implant fixation and stabilization of the fracture. These 2 processes go hand-in-hand and generally the implant is revised to one with a longer stem it goes down the inside of the bone and a plate which stabilized the fracture on the outside of the bone. This titer. Significantly larger than merely repairing the fracture as in cases where the implant is not loosening. Most patients remain in the hospital for 7-10 days and recovery is slow with normal walking and proximally 6-8 months after repair.

A second fall resulting a a second fracture below the plate

One of the more devastating competitions after surgery is an additional fall with refracture of the bone below where the plate is been placed. This results in need for additional surgery and significantly slows the overall recovery process. As a result I cautioned patients to be careful in her gait and walking for least the first 3 months after surgery or until they regain adequate muscle strength in the leg.

A second surgery is performed with a longer plate