Discusión entre pares / 60 year old gentleman presented with fracture neck of femur ...

Vivek Chhimpa

60 year old gentleman presented with fracture neck of femur ...cemented modular bipolar hemi done and second post op day x ray showed periprosthetic fracture...line of management....

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  Somnath Chowdhury cable plate. preferable to revise the stem as it is in varus n lateralised position. long stem wud be required. cable plate fixation ideal for these cases.

  
  
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  DrDhiren Faldu revise it if affording then uncemented restoration type long stem with circlage if non affording revise with long cemented stem exeter type and circlage. here only circlage cant choice due to cemented stem with displaced fracture.

  
  
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  Biju Nair If you see the preop x ray - is there a lytic area there - subtrochanteric?

  
  
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  Ashutosh Chaudhari if i were you i would first try and analyse why this happened,i have never seen a periprosthetic in a cem implant except in my residency when my lecturer hammered the prosthesis but that was because the cem started to set and the fellow had forgotten to take the implant ,which makes me feel like biju pointed out ,keep possibility of mets and multiple myeloma before proceeding ,in myeloma ,the cement leaks out i have done a bipolar for a known case of myeloma ,cannot explain the frac

  
  
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  Sachit Malhan Type c are not that un common. If cable plate available then good or else lcp plus wiring. Yes it is good practice to rule out mets or pathological but trivial trauma can also cause this without pathology.

  
  
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  Ali Öner Vancouver type C, which requires revision. 'Only cable/cerclage wiring' is certainly not acceptable.
  
  Removal of cement, reconstruction of femur with plate and cables, then cemented or cementless, some long stem is enough.

  
  
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  Abubaker Musa You can do LCB (ORIF) proximal to the fracture unicortical screw &distal to the fracture bicortical screw

  
  
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  Sachit Malhan Ali this is not ,only cable, but cable plating. We have plates with side holes through which cables or ss wires can be inserted for extra secure fixation.

  
  
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  Vivek Chhimpa removal of cement restricter distally, encirclage, LCP , bone grafting...

  
  
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  Vivek Chhimpa

  

  
  
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  Vivek Chhimpa post op xray..

  

  
  
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  Biju Nair Extreme stress risers are going to come at the tip of the implant. Revision to long stem implant indicated as definitely there was implant loosening (Type C)