Outcome after proximal femoral fractures during primary total hip replacement by the direct anterior approach.

Details

Ressource 1Download: BIB_FCE30C4ADFDC.P001.pdf (204.37 [Ko])
State: Public
Version: Final published version
Serval ID
serval:BIB_FCE30C4ADFDC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcome after proximal femoral fractures during primary total hip replacement by the direct anterior approach.
Journal
Archives of Orthopaedic and Trauma Surgery
Author(s)
Rüdiger H.A., Betz M., Zingg P.O., McManus J., Dora C.F.
ISSN
1434-3916 (Electronic)
ISSN-L
0936-8051
Publication state
Published
Issued date
2013
Volume
133
Number
4
Pages
569-573
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
BACKGROUND: The literature suggests that intraoperative fractures of the greater trochanter and the metaphysis are increased with uncemented stems and the direct anterior approach. This study aims to determine the incidence and assess the functional and radiological outcome after such fractures.
METHODS: 484 consecutive total hip replacements (THR) (64 ± 12 years) were analyzed. We treated trochanteric fractures conservatively without any further denuding, and secured metaphyseal fissures with cerclages. Postoperative X-rays and at the latest follow-up were compared to assess secondary fracture displacement and stem subsidence. Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores after 1 year were analyzed. For each patient sustaining a fracture, two patients without fractures were matched in terms of age, body mass index and gender.
RESULTS: 13 (2.7 %, 5 male, 68 ± 9 years) patients with intraoperative fractures of the greater trochanter (n = 8) or the metaphysis (n = 5) were analyzed. Consolidation was observed in 7/8 patients sustaining a trochanteric fracture while secondary displacement of the fragment occurred in one case. Stem subsidence was observed in 2/5 cases (5 and 7 mm). Patients who sustained a fracture showed a trend towards poorer WOMAC scores at 1 year postoperatively, compared to patients without fractures. A significantly increased joint stiffness was also observed.
CONCLUSION: The intraoperative fracture risk in this series of THR through a direct anterior approach was 2.7 %. Trochanteric fractures do heal without primary fixation. Metaphyseal fractures heal well if immediately stabilized with a cerclage.
Pubmed
Web of science
Create date
12/04/2013 17:15
Last modification date
20/08/2019 16:27
Usage data