Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Section 1 Shoulder
- Section 2 Arm
- Section 3 Elbow
- Section 4 Forearm
- Section 5 Wrist
- Section 6 Hand
- Section 7 Hip and Pelvis
- Case 45 Femoroacetabular impingement: cam- versus pincer-type
- Case 46 Snapping hip
- Case 47 Labral tear versus cleft versus labral recess
- Case 48 Transient bone marrow edema of the hip (transient osteoporosis) versus osteonecrosis
- Case 49 Hip fractures in the elderly
- Case 50 Insufficiency fractures of the pelvis
- Case 51 Mild-to-moderate acetabular maldevelopment in the adult hip
- Case 52 Calcific tendinitis of the hip
- Case 53 Hip arthroplasty: periprosthetic fracture in the femur
- Section 8 Thigh
- Section 9 Leg
- Section 10 Ankle
- Section 11 Foot
- Section 12 Tumors/Miscellaneous
- Index
- References
Case 53 - Hip arthroplasty: periprosthetic fracture in the femur
from Section 7 - Hip and Pelvis
Published online by Cambridge University Press: 05 July 2013
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Section 1 Shoulder
- Section 2 Arm
- Section 3 Elbow
- Section 4 Forearm
- Section 5 Wrist
- Section 6 Hand
- Section 7 Hip and Pelvis
- Case 45 Femoroacetabular impingement: cam- versus pincer-type
- Case 46 Snapping hip
- Case 47 Labral tear versus cleft versus labral recess
- Case 48 Transient bone marrow edema of the hip (transient osteoporosis) versus osteonecrosis
- Case 49 Hip fractures in the elderly
- Case 50 Insufficiency fractures of the pelvis
- Case 51 Mild-to-moderate acetabular maldevelopment in the adult hip
- Case 52 Calcific tendinitis of the hip
- Case 53 Hip arthroplasty: periprosthetic fracture in the femur
- Section 8 Thigh
- Section 9 Leg
- Section 10 Ankle
- Section 11 Foot
- Section 12 Tumors/Miscellaneous
- Index
- References
Summary
Imaging description
Periprosthetic fractures involving the femur in the setting of hip arthroplasty are not rare. Periprosthetic acetabular fractures in the setting of arthroplasty are rare. Periprosthetic femur fractures are classified using the Vancouver classification system since it is reproducible and helps determine the type of treatment to be used. Fractures can occur at or about the femoral component or distal to the femoral component (Figure 53.1). They are readily detected on radiographs. A faint longitudinal linear lucency seen about the femoral stem tip in the immediate post-operative period may represent an artifact or longitudinal fracture; however, it can be treated conservatively (Figure 53.2).
Importance
Lesser trochanter and greater trochanter periprosthetic fractures are usually treated conservatively while femoral shaft perihardware fractures are treated with reduction and internal fixation (as long as the prosthesis is not loose). If there is hardware loosening present in addition to the fracture, then a revision arthoplasty with or without a graft is performed. A faint longitudinal linear lucency seen about the femoral stem tip in the immediate post-operative period may represent an artifact; however, it can be treated conservatively as well.
Typical clinical scenario
A 70-year-old female with a history of a right total hip arthroplasty 4 months ago presents with sudden onset of hip and right leg pain after a fall. She is unable to bear weight on the right leg. Radiographs demonstrate a femoral shaft fracture about the femoral stem of the right hip prosthesis. There is no evidence of perihardware loosening, and she has no clinical evidence of infection. The fracture was treated with reduction and interval fixation.
Teaching point
Trochanteric periprosthetic fractures are usually treated conservatively. Femoral shaft periprosthetic fractures in well-fixed prostheses usually require reduction and internal fixation with or without a graft. Loosened prostheses with a femoral shaft fracture generally require a revision arthroplasty. A faint longitudinal linear lucency seen about the femoral stem tip in the immediate postoperative period may represent an artifact; however, it can be treated conservatively.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Musculoskeletal ImagingVariants and Other Difficult Diagnoses, pp. 112 - 113Publisher: Cambridge University PressPrint publication year: 2013