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Case Reports
. 2020 Mar 6:26:100287.
doi: 10.1016/j.tcr.2020.100287. eCollection 2020 Apr.

Nightmare of repeated low-energy periprosthetic femoral fracture in a patient with severe osteoporosis - A lesson learned

Keith Hay-Man Wan  1 , Siu-Tong Choi  1 , Kevin Kh Wong  1 , Kam-Kwong Wong  1
Affiliations
Case Reports

Nightmare of repeated low-energy periprosthetic femoral fracture in a patient with severe osteoporosis - A lesson learned

Keith Hay-Man Wan et al. Trauma Case Rep. .

Erratum in

Abstract

We report an 85-year-old patient with severe osteoporosis who had suffered from multiple episodes of periprosthetic fracture of the femur. Revision fixation with long-spanning cable plate for bisphosphonate-induced atypical periprosthetic femoral fracture was performed. Nonunion and implant failure occurred at 16 months requiring revision surgery using long-stem femoral prosthesis with cable-plate fixation. To further facilitate bone healing, allograft and bone morphogenetic protein (BMP) were added. Eventually bone union was achieved after one year.

Keywords: Alendronate; Arthroplasty; Case report; Fracture; Hip; Non-union; Periprosthetic fractures; Stress.

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Figures

Fig. 1
Fig. 1
Radiograph (AP view) showing Vancouver's B1 periprosthetic fracture of the left femur.
Fig. 2
Fig. 2
Radiographs (lateral view) showing Vancouver's B1 periprosthetic fracture of the left femur.
Figs. 3
Figs. 3
Open reduction and internal fixation with locking cable-plate (Post-op AP view).
Fig. 4
Fig. 4
Open reduction and internal fixation with locking cable-plate (Post-op lateral view).
Fig. 5
Fig. 5
Intra-operative photo.
Fig. 6
Fig. 6
Radiograph (AP view) showing satisfactory fracture healing 6 months after the operation.
Fig. 7
Fig. 7
Radiograph (lateral view) showing satisfactory fracture healing 6 months after the operation.
Fig. 8
Fig. 8
Radiograph (AP view) showing a periprosthetic fracture around the stem tip.
Fig. 9
Fig. 9
Radiograph (lateral view) showing a periprosthetic fracture around the stem tip.
Fig. 10
Fig. 10
Revision fixation with pre-contoured long-spanning femur locking plate that covers the greater trochanter with complete overlapping with the stem (radiograph AP view).
Fig. 11
Fig. 11
Fig. 11: Revision fixation with pre-contoured long-spanning femur locking plate that covers the greater trochanter with complete overlapping with the stem (radiograph lateral view).
Fig. 12
Fig. 12
Intra-operative photo.
Fig. 13
Fig. 13
Radiograph (AP view) showing non-union over the fracture site without displacement.
Fig. 14
Fig. 14
Radiograph (latera view) showing non-union over the fracture site without displacement.
Fig. 15
Fig. 15
Radiograph (AP view) showing breakage of the locking plate with fracture displacement.
Fig. 16
Fig. 16
Radiograph (lateral view) showing breakage of the locking plate with fracture displacement.
Fig. 17
Fig. 17
Intra-operative photo showing a broken locking plate, which was removed together with the hip prosthesis.
Fig. 18
Fig. 18
Removal of the broken implants.
Fig. 19
Fig. 19
Intra-operative photos showing cement removal with the assistance of OSCAR.
Fig. 20
Fig. 20
Intra-operative photos showing cement removal with the assistance of OSCAR.
Fig. 21
Fig. 21
Intra-operative photos showing a piece of allograft was chiselled and lodged into the fracture gap.
Fig. 22
Fig. 22
Intra-operative photos showing a piece of allograft was chiselled and lodged into the fracture gap.
Fig. 23
Fig. 23
Radiograph (AP view) one year after the revision surgery showing stable bone union.
Fig. 24
Fig. 24
Radiograph (lateral view) one year after the revision surgery showing stable bone union.
See this image and copyright information in PMC

References

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