A Rare Case of Open (Gustilo II) Periprosthetic Fracture (Vancouver B2) in a Polytraumatized Patient

Document Type : CASE REPORT

Authors

1 San Luigi Gonzaga, Department of Orthopedics and Traumatology, Orbassano (Turin), Italy/Department of Surgical Sciences, University of Turin, Turin, Italy

2 Michele and Pietro Ferrero Hospital, Verduno, Italy

Abstract

Periprosthetic femoral fracture is the third most frequent complication after total hip replacement (THR). It is mainly caused by low-energy trauma in the elderly. Open periprosthetic fractures are significantly rarer and are caused by high-energy trauma. Here we present a case of a 73-year-old man who sustained an open (Gustilo II) left periprosthetic femoral fracture with an unstable femoral component (Vancouver B2). After an early stabilization with a temporary external fixator, a single-stage revision using a tapered long femoral stem was performed. At the last follow-up (3.2 years), the patient was satisfied and walked without pain and aids, and the Harris Hip Score was 83.5. No signs of infection or osteolysis were present in the last radiographs.
Level of evidence: V

Keywords

Main Subjects


1. Ackerman IN, Busija L, Lorimer M, de Steiger R, Graves SE. Monitoring the lifetime risk of revision knee arthroplasty over a decade : a population-level analysis of Australian national registry data. Bone Joint J. 2022; 104-B (5):613-619. doi:10.1302/0301-620X.104B5.BJJ-2021-1219.R1.
2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780-785. doi:10.2106/JBJS.F.00222.
3. Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005; 20(7):857-65. doi: 10.1016/j.arth.2005.02.001.
4. Mancino F, Cacciola G, Di Matteo V, et al. Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty. Orthop Rev (Pavia). 2020; 12(Suppl 1):8655. Published 2020 Jun 25. doi:10.4081/or.2020.8655.
5. Rau CS, Wu SC, Kuo PJ, Chen YC et al. Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach. Int J Environ Res Public Health. 2017 Sep 11; 14(9):1045. doi: 10.3390/ijerph14091045.
6. De Meo F, Cacciola G, Bellotti V, Bruschetta A, Cavaliere P. Trabecular Titanium acetabular cups in hip revision surgery: mid-term clinical and radiological outcomes. Hip Int. 2018;28(2_suppl):61-65. doi:10.1177/1120700018812992.
7. Cacciola G, Giustra F, Bosco F, et al. Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature [published online ahead of print, 2023 Feb 27]. Eur J Orthop Surg Traumatol. 2023; 10.1007/s00590-023-03497-y. doi: 10.1007/s00590-023-03497-y.
8. Roberts CS, Pape HC, Jones AL, Malkani AL, Rodriguez JL, Giannoudis PV. Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma. Instr Course Lect. 2005; 54:447-462.
9. Weber D, Dulai SK, Bergman J, Buckley R, Beaupre LA. Time to initial operative treatment following open fracture does not impact development of deep infection: a prospective cohort study of 736 subjects. J Orthop Trauma. 2014; 28(11):613-619. doi:10.1097/BOT.0000000000000197.
10. Rütter JE, de Vries LS, van der Werken C. Intramedullary nailing of open femoral shaft fractures. Injury. 1994 Sep; 25(7):419-22. doi: 10.1016/0020-1383(94)90264-x.
11. Aleem IS, Bhandari M, Elizalde SR. Early Definitive Fixation of an Open Periprosthetic Femur Fracture in the Polytraumatized Patient: A Case Report and Review of the Literature. J Orthop Case Rep. 2016; 6(1):33-36. doi:10.13107/jocr.2250-0685.371.                                                                                                                                          12. Rodriguez L, Jung HS, Goulet JA, Cicalo A, Machado-Aranda DA, Napolitano LM. Evidence-based protocol for prophylactic antibiotics in open fractures: improved antibiotic stewardship with no increase in infection rates. J Trauma Acute Care Surg. 2014;77(3):400-524. doi:10.1097/TA.0000000000000398.
13. Bosco F, Cacciola G, Giustra F, et al. Characterizing recurrent infections after one-stage revision for periprosthetic joint infection of the knee: a systematic review of the literature [published online ahead of print, 2023 Mar 3]. Eur J Orthop Surg Traumatol. 2023; 10.1007/s00590-023-03480-7. doi: 10.1007/s00590-023-03480-7.
14. Grosso MJ, Kozaily E, Cacciola G, Parvizi J. Characterizing Femoral and Acetabular Bone Loss in Two-Stage Revision Total Hip Arthroplasty for Infection. J Arthroplasty. 2021; 36(1):311-316. doi:10.1016/j.arth.2020.07.024.
15. Lazic I, Scheele C, Pohlig F, von Eisenhart-Rothe R, Suren C. Treatment options in PJI - is two-stage still gold standard?. J Orthop. 2021; 23:180-184. Published 2021 Jan 20. doi:10.1016/j.jor.2020.12.021.
16. Morshed S, Miclau T 3rd, Bembom O, Cohen M, Knudson MM, Colford JM Jr. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009; 91(1):3-13. doi:10.2106/JBJS.H.00338.
17. Maury AC, Pressman A, Cayen B, Zalzal P, Backstein D, Gross A. Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. J Bone Joint Surg Am. 2006; 88(5):953-958. doi:10.2106/JBJS.E.00120.