假体周围骨折的分型与治疗方案-课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Periprosthetic FracturesClassification and Treatment,Periprosthetic FracturesClass,1,Increasing Numbers,More Arthroplasties,More Internal Fixation Osteoporotic Fractures,More Independent Elderly,More Revisions,Increasing NumbersMore Arthrop,2,Incidence Increasing,Between 1987 2003,Incidence 0.14%,Between 2004 2007,Incidence 0.78%,?,Earlier Mobilization,Smaller Incisions,Proximally Coated Stems,?,Berry et.al.2007,“,it is becoming a little bit of a mini epidemic.”,D.Berry,MD,Incidence IncreasingBetween 19,3,假体周围骨折的分型与治疗方案-课件,4,假体周围骨折的分型与治疗方案-课件,5,Intraoperative FractureTreatment,Fracture Proximal To Lesser Trochanter,Cables,Collared Implant,Perforations,Longer Stem-bypass Perforation By 2 1/2 Canal Diameters,+/-Supplemental Bone Grafting,Intraoperative FractureTreatm,6,Periprosthetic FracturesRisk Factors,Decreased bone strength,Perforations,Loose stem,Osteolysis,Stress risers,Screw holes,Periprosthetic FracturesRisk,7,Treatment Goals,United Fracture,Anatomic Alignment,Stable Prosthesis,Early Mobilization,Return To Previous Function,Treatment GoalsUnited Fracture,8,Treatment,Many Option/Permutations,Non-operative,Revision Arthroplasty,And/Or,ORIF,And/Or,Strut Grafting,No Clear Consensus,Each Case Must Be Individualized,TreatmentMany Option/Permuta,9,Critical Factors,Stability Of The Prosthesis,Location Of The Fracture,Relative To Prosthesis,Quality Of Bone,Patient,Age,Medical Condition,Baseline Status,Critical FactorsStability Of T,10,Vancouver Classification(Fractures About THA Stems),Considerations,Location Of The Fracture,Implant Stability,Bone Quality,Vancouver Classification(Frac,11,Vancouver Classification,Type determined by location,Type A,Trochanteric region,Type B,About tip of stem,Type C,Distal to tip of stem,Vancouver ClassificationType d,12,Type B(At Tip)Sub Classification,Type B1,Implant Is Stable,Type B2,Implant Is Loose,Satisfactory Bone,Type B3,Implant Is Loose,Inadequate Bone Stock,Type B(At Tip)Sub Classifica,13,Treatment,Type A-Trochanteric Region,Usually Stable,Protected WB,ORIF,Cables,Plate,Plate+Cables,TreatmentType A-Trochanteric,14,Vancouver Type CTreatment,ORIF,Avoid Stress Riser Between Implants,Overlap Fixation Device With Implant,Maintain 2 Cortical Diameters Between Devices,Vancouver Type CTreatmentORIF,15,TreatmentVancouver Type B FracturesMost Difficult,TreatmentVancouver Type B Fra,16,Type B1,Stable Implant,No Bone Loss,ORIF Vs Revision?,+/-Cortical Onlay Strut Grafting?,Consider Difficulty of Stable Implant Removal,Type B1Stable Implant,17,Type B2 and B3 Fractures,Loose Implant,Revision Arthroplasty,Bone Loss,Bone graft,Type B2 and B3 FracturesLoose,18,Case Example,Case Example,19,假体周围骨折的分型与治疗方案-课件,20,Initial Cerclage Reduction,Initial Cerclage Reduction,21,Plate Application,Plate Application,22,Long Fixation Span,Long Fixation Span,23,Conclusions,Vancouver Classification Helpful in Treatment Decisions,Indirect Reduction If Plate Used,Cables and Onlay Grafts Helpful,Think LONG on Plates and Nails,Always Think of the Next Operation,ConclusionsVancouver Classific,24,Thank You,Thank You,25,