股骨假体周围骨折英文PPT课件

1、Objectivesl Goalsl Epidemiologyl Risk factorsl Classificationl Treatment第1页/共35页Goals of Treatmentl fracture unionl anatomic alignmentl return to functional statusl early mobilizationl stable prosthesis at the end of fracture healingl reasonable survivorship of the prosthesis第2页/共35页Femoral Peripros

2、theic Fractures Epidemiology incidence0.564.2% Uncommon but Unique Challenges !第3页/共35页Risk Factors Old age Female Trauma Index diagnosis Revision Implants Technique Loose implant (aseptic) Rheumatoid Osteopenia Osteolysis第4页/共35页Vancouver Type AFractures in the trochanteric regionAG: fractures of t

3、he greater trochanterAL: fractures of the lesser trochanterClassification第5页/共35页 Type BStem region with the stem firmly in placeWith loose stemWith bone defect presentAround or just distal to stem 第6页/共35页 Type CWell below stem第7页/共35页B1 Good bone no implant looseningB2 Good bone with implant loose

4、ningB3 Poor bone or bone defect, implant looseningUnified Classification SystemUCS第8页/共35页Unified Classification System第9页/共35页Treatment Pre-op Planning rule out infection implant fixation ESR CRP revision tumor prosthesis IM nail LCP Cable Biological plate Other get help escape plan第10页/共35页Surgica

5、l solutionsl Internal fixation l Revision of prosthetic componentsplatingnailing 第11页/共35页l conservationl trochanter platel cerclage wiresStable UCS .3 A( Type A)第12页/共35页l LCPl cablesl biological plate79 yrs MlLCP with titanium cable system UCS .3 B1 ( Type B1)Dr. F. LIU第13页/共35页Locking-compression

6、 plates (LCP) locking-head screw (LHS)a LCP DF ( for distal femur)b LCP PT ( for proximal tibia)c LHS ( monocortical short ) for placement in the vicinity of a prosthetic stemVariable-angle locking compression plate (VA-LCP) and locking head screw (LHS)a VA-LCP ( for distal femur)b Angulations of po

7、ssible screw directionsc Design of a VA-LHS screw head第14页/共35页l LCP with Locking Attachment Plate第15页/共35页第16页/共35页SHI RH, 77yrs, F, 1277045 Classification ? UCS .3 B1 (Vancouver type B1)Dr. F. LIU第17页/共35页l LCP with Locking Attachment PlateSurgical solution第18页/共35页Dr. F. LIUDr. F. LIU第19页/共35页Dr.

8、 F. LIUDr. F. LIU第20页/共35页JI DC, 62yrs, M, 1341747 UCS .3 B1 (Vancouver type B1)LCP with titanium cable system Dr. F. LIUDr. F. LIU第21页/共35页 UCS .3 B2 (Type B2)59 yrs, MDr. F. LIU第22页/共35页l revisionl LCP long stem with cable system tumor prostheticwith titanium cables system Surgical solution UCS .3

9、 B2 (Type B2)第23页/共35页第24页/共35页第25页/共35页JI MF, 62yrs, F, 1277986Dr. F. LIUDr. F. LIUDr. F. LIU第26页/共35页l LISSl LCP Cables UCS .3 C ( Type C)Dr. F. LIUSurgical solution第27页/共35页第28页/共35页Dr. F. LIU第29页/共35页Dr. F. LIU第30页/共35页第31页/共35页Dr. F. LIUDr. F. LIU第32页/共35页Summary l Uncommon but challengingl Two hats