Retrograde intramedullary nailing below a hip arthroplasty prosthesis: a viable fixation option for periprosthetic and i
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ORIGINAL PAPER
Retrograde intramedullary nailing below a hip arthroplasty prosthesis: a viable fixation option for periprosthetic and interprosthetic femur fractures Raveesh D. Richard 1
&
Roman M. Natoli 2 & Anthony T. Sorkin 2 & Walter W. Virkus 2 & Greg E. Gaski 2
Received: 28 April 2020 / Accepted: 14 July 2020 # SICOT aisbl 2020
Abstract Background Periprosthetic femur fractures (PPFF) distal to a femoral stem are traditionally treated with open reduction and internal fixation (ORIF) with plate and screws. To our knowledge, no studies exist comparing outcomes following ORIF vs retrograde intramedullary nails (RIMN) for this injury. Methods This is a retrospective comparison of PPFFs distal to a femoral stem treated by ORIF (n = 17) vs RIMN (n = 13). The primary outcome was unplanned re-operation. Results There was no difference in unplanned re-operation (17.6 vs 23.1%, p > 0.99), infection, nonunion, refracture, and alignment between groups. The RIMN group had shorter surgical time (89 vs 157 min, p < 0.01), less blood loss (137 vs 291 ml, p = 0.03), and greater obesity. Conclusion RIMN is a potential option for operative fixation of PPFF distal to a femoral stem worthy of additional study. Keywords Periprosthetic . Interprosthetic . Femu . Fracture . Retrograde . Nail . Intramedullary . ORIF . internal fixation
Introduction Periprosthetic femur fractures (PPFF) are a growing epidemic worldwide, with some authors estimating that the incidence of such injuries may reach 5% by 20 years after primary total hip arthroplasty (THA) [1–4]. As a result of Investigation performed at Indiana University Methodist Hospital in Indianapolis, Indiana * Raveesh D. Richard [email protected] Roman M. Natoli [email protected] Anthony T. Sorkin [email protected] Walter W. Virkus [email protected] Greg E. Gaski [email protected] 1
Centura Orthopaedics & Spine, 9949 S. Oswego St, Ste 200, Parker, CO 80134, USA
2
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
increased THA and total knee arthroplasty (TKA) procedures over time and the expanded indications to sicker and older patients, the burden of periprosthetic femur fractures is expected to steadily rise. Traditionally, fractures distal to a femoral stem have been treated with open reduction and internal fixation with a plate and screw construct overlapping the stem. This has also been the standard fixation method for interprosthetic fractures between THA and TKA prostheses. Previous biomechanical studies have supported this method of fixation citing evidence that a distal locking plate bypassing a prosthetic stem requires a greater fracture force to break the femur below the stem compared with other fixation constructs [5–8]. To our knowledge, there are no clinical studies comparing outcomes in patients with periprosthetic femur fractures distal to a femoral stem treated with different implants. At our institution, distal periprosthetic and interprosthetic femur fractures are routinely treated w
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