假体周围骨折的分型与治疗方案ppt课件

Periprosthetic FracturesPeriprosthetic Fractures Classification and TreatmentClassification and Treatment Increasing NumbersIncreasing Numbers More ArthroplastiesMore Arthroplasties More Internal Fixation More Internal Fixation Osteoporotic FracturesOsteoporotic Fractures More Independent ElderlyMore Independent Elderly More RevisionsMore Revisions Incidence IncreasingIncidence Increasing Between 1987 2003Between 1987 2003 Incidence 0.14%Incidence 0.14% Between 2004 2007Between 2004 2007 Incidence 0.78%Incidence 0.78% ? Earlier MobilizationEarlier Mobilization Smaller IncisionsSmaller Incisions Proximally Coated StemsProximally Coated Stems ? Berry et. al. 2007 “it is becoming a little bit of a mini epidemic.” D. Berry, MD Intraoperative FractureIntraoperative Fracture Cemented Hip StemCemented Hip Stem 2 Cortical Maintain 2 Cortical Diameters Between DevicesDiameters Between Devices TreatmentTreatment Vancouver Type B FracturesVancouver Type B Fractures Most DifficultMost Difficult Type B1Type B1 Stable ImplantStable Implant No Bone LossNo Bone Loss ORIF Vs Revision?ORIF Vs Revision? +/- Cortical Onlay Strut Grafting?+/- Cortical Onlay Strut Grafting? Consider Difficulty of Stable Implant Consider Difficulty of Stable Implant RemovalRemoval Type B2 and B3 FracturesType B2 and B3 Fractures Loose ImplantLoose Implant Revision Revision ArthroplastyArthroplasty Bone LossBone Loss Bone graftBone graft Case ExampleCase Example Initial Cerclage ReductionInitial Cerclage Reduction Plate ApplicationPlate Application Long Fixation SpanLong Fixation Span ConclusionsConclusions Vancouver Classification Helpful in Treatment DecisionsVancouver Classification Helpful in Treatment Decisions Indirect Reduction If Plate UsedIndirect Reduction If Plate Used Cables and Onlay Grafts HelpfulCables and Onlay Grafts Helpful Think LONG on Plates and NailsThink LONG on Plate