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Proximal Femoral Fracture After Hip Resurfacing Managed with Blade-Plate FixationA Case Report
Patrick Weinrauch, MBBS(Qld), MEng, FRACS(Orth)1; Steve Krikler, BSc, PhD, FRCS(Orth)2
1 St. Andrews War Memorial Hospital, 33 North Street, Spring Hill 2LD 4000 Australia. E-mail address: p.weinrauch@qut.edu.au
2 Department of Orthopaedics and Trauma, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jun 01;90(6):1345-1347. doi: 10.2106/JBJS.G.00950
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Extract

Periprosthetic and proximal femoral fractures that occur after hip resurfacing are a challenging problem which, with the increasing popularity of resurfacing arthroplasty, is likely to increase in frequency. In the presence of a well-fixed acetabular component, periprosthetic femoral neck fractures about a hip resurfacing implant may be successfully managed by isolated revision of the femoral component and retention of the socket. However, successful internal fixation of the fracture would allow retention of the femoral implant and salvage of a previously well-functioning resurfacing prosthesis. When the resurfacing femoral component is retained, however, the presence of the implant stem, which is centrally located in the femoral neck, causes difficulty in placing the typical implants (e.g., a screw-plate device or a cephalomedullary nail) that are used in the management of intertrochanteric and proximal femoral fractures.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Neil M Orpen
    Posted on November 23, 2008
    An Alternative Method to Treat Proximal Femoral Fractures After Hip Resurfacing Arthroplasty
    Spinal Fellow

    To the Editor:

    We read the article by Weinrauch and Krikler (1) with interest and we would like to present to your readers an alternative method of fixation for this fracture that we have found useful in two similar instances.

    Two male patients in their 50's sustained proximal femoral fractures below a resurfacing arthroplasty. One injury was a simple intertrochanteric fracture but the second involved a mutifragmented pattern with a reverse oblique element. Both of these were successfully fixed with a non- contact bridging(NCB)locking plate(Zimmer)with variable axis screws into the femoral neck. Although this plate is designed to fix distal femoral fractures, we have found that by reversing the plate it provides a good purchase when treating femoral neck fractures. A further benefit of this device is that the variable axis screws into the femoral neck allow a good hold adjacent to the stem of the femoral component.

    There is very little published literature on how to deal with this injury and we expect similar fractures to occur more frequently as resurfacing arthoplasty becomes more common. We hope that by reporting such methods of fixation, we will provide good options for those who have to deal with this injury in the future.

    References:

    1. Patrick Weinrauch and Steve Krikler Proximal Femoral Fracture After Hip Resurfacing Managed with Blade-Plate Fixation. A Case Report J Bone Joint Surg Am 2008; 90: 1345-1347

    The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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