ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Biologic mechanisms governing the consolidation of bone graft is a subject of importance to the practice of orthopaedic surgery. The following is a precis describing these mechanisms, complications, and the potential directions of future research into graft incorporation.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:When a periprosthetic fracture about the knee or hip is associated with segmental bone loss and a loose implant, a structural allograft may be indicated. The implant is cemented into the allograft but not into the host. The host graft junction is stabilized by the long stem of the implant and a step-cut osteotomy. The junction can be further reinforced by cortical strut allograft and residual host bone with soft tissues still attached to enhance union. Once the host bone unites to the allograft, the reconstruction is stabilized. If the implant is stable with no loss of bone stock, cortical strut allografts fixed by cerclage wires can be used as biologic plates to stabilize the fracture.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:The difficulty in treating a periprosthetic fracture following total hip arthroplasty is evidenced by the many modalities and techniques currently described in the orthopaedic literature. There is no ideal treatment that is appropriate for all fractures. A number of classification systems have previously been proposed; however, these mainly depend only on the site or pattern of the fracture. We propose a classification system that incorporates such factors as location of the fracture, status of stem fixation, and quality of bone stock. When these various factors are considered, they allow for a more rational approach to treatment.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Periprosthetic fractures of the femur after total hip arthroplasty are challenging to the orthopaedic surgeon. Location of the fracture and stability of the implant are the keys to their treatment. Fractures proximal to the tip of the stem, around a loose component, should be treated with a long stem revision. Fractions distal to a well-fixed component should be treated with extramedullary plate fixation using screws and cerclage wires.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:This article outlines the classification and treatment of periprosthetic acetabular fractures. Although these fractures are uncommon, they may be on the rise with the use of cementless press-fit components and as more components remain in service for long periods of time with development of bone loss associated with component loosening.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Fractures that occur after total hip arthroplasty tend to occur through stress risers in the femoral cortical bone with the most common cause being a fall indoors. Most fractures occur following a revision operation but many occur through osteolytic defects in primary hips. The Vancouver classification system is described and used to discuss recommendations for management. Type A-G and A-L fractures involve the trochanters, are usually minimally displaced, and in most cases can be treated non operatively. Fractures that occur at the tip of a stem (type B) are the most common type. Fractures with a stable stem (B-l) can be treated with open reduction and internal fixation (ORJF), but fractures associated with a loose stem (B-2) require a revision, usually to a long stem. Revision with an allograft is recommended for fractures associated with significant bone loss (B-3) in younger, active patients whereas revision with a proximal femoral replacement stem may be advisable for older, sedentary patients. Type C fractures, which occur well below the stem tip, can be treated non operatively if minimally displaced; however, unstable type C fractures are best treated with ORIF. Avoiding the creation of stress risers and regular radiographic follow up to detect osteolysis may help decrease the incidence of periprosthetic fractures.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Supracondylar fractures following total knee arthroplasty are an infrequent yet complex complication occurring most commonly after minimal falls. Risk factors are focused on conditions associated with osteopenia. A plethora of nonoperative and operative treatment methods have been used to treat these fractures. Obtaining and maintaining fracture alignment is critical for optimal results. Review of recent studies indicates superior results with operative methods in displaced fractures, particularly with use of interlocking supracondylar rods. Tibial fractures involving the tibial component interface are best managed with component revision, typically incorporating a diaphyseal-engaging tibial intramedullary stem. Those tibial fractures that are not associated with instability, malalignment, or component loosening are treated using standard principles of tibial fracture care.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Periprosthetic fractures of the proximal femur are uncommon. The results of treatment have not been uniformly satisfactory. The most important features that should be ascertained are the pretreatment prosthetic status and the site of fracture; the extent of osteopenia helps to determine whether allograft or other grafting are indicated. An algorithm based on a review of periprosthetic fractures and personal experience suggests appropriate therapy.

ISSN:0885-9698    

出版商:OVID    

年代:1999

数据来源: OVID