Volume 24, Issue 104, July - August, 2020

Intraoperative periprosthetic fracture of femur in a case of revision total hip replacement: A case report

Gajanan Pisulkar¹, Kiran Saoji², Dhruva U Angachekar³, Mohit Dadlani⁴, Priyanshu Pandey⁵

¹Professor, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi Meghe, Wardha, India. Email: glpworld1@gmail.com, 9822235475
²Professor and Head, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi Meghe, Wardha, India. Email: kiran.saoji@gmail.com, 9422103298
³Junior Resident, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi Meghe, Wardha, India. Email: drdhruva55@gmail.com, 8291026092
⁴Junior Resident, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi Meghe, Wardha, India. Email: dadlanimohit786@gmail.com, 7987539587
⁵Junior Resident, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi Meghe, Wardha, India. Email: priyanshup94@gmail.com, 8237133769

ABSTRACT

Introduction: The numbers of patients undergoing total hip arthroplasties are continuously increasing and with that so are cases of periprosthetic fractures.They can be either intraoperative or post-operative. Most intraoperative femoral fractures occur during insertion of the femoral stem. Multiple methods are available for fixation but principles of stable fracture fixation should be used while fixing these fractures. Case: A 72 year old male who had undergone left sided bipolar hemiarthroplasty for neck of femur fracture 2 years back presented with pain in the left hip since 1 year. X rays show loosening of bipolar stem in medullary canal with lateralisation of tip of stem. Severe osteoporosis was noted. The patient was taken up for revision total hip arthroplasty. There occurred a Vancouver type B1 fracture during insertion of the femoral stem. Immediate fixation of the fracture was done using a LCDCP contoured to the desired shape. On 7th post-operative day patient started complaining of pain in left thigh. Repeat X rays showed plate failure with displacement of fracture. Due to corona virus pandemic patient was given skeletal traction and leg put on BB splint. After 6 weeks the patient was managed with open reduction and internal fixation using Trochanteric bridge plate with screws and titanium cables. While passing encirclage wire there was damage to the superficial femoral artery. Patient was started on anticoagulants and started guarded walking on the 7th post-operative day. Conclusion: Vancouver type B periprosthetic femur fractures are unstable and require internal fixation and stabilisation. A long Limited contact plate extending from the greater trochanter to an adequate distance beyond the fracture site gives good structural stability.

Keywords: Total hip replacement, femur fracture, intraoperative periprosthetic femur fracture

Medical Science, 2020, 24(104), 2691-2699

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