Orthop Traumatol Sur
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Orthop Traumatol Sur · Nov 2011
Multicenter StudyInterprosthetic femoral fractures: analysis of 14 cases. Proposal for an additional grade in the Vancouver and SoFCOT classifications.
Interprosthetic fracture is a rare but serious entity, impairing consolidation and stability due to adverse mechanical conditions related to bone fragility and implant volume. ⋯ To describe the status of the intermediate femur and its medullary canal encumbrance, we propose adding a category D to the SoFCOT and Vancouver classifications, corresponding to interprosthetic fracture on TKR with diaphyseal extension stem. Interprosthetic fracture internal fixation should begin with long devices bridging the two prostheses. When the implant is loose, it may be replaced; in case of diaphyseal extension, however, the residual femur between the two extensions should be protected against peak stress by a plate extending upward and downward. In case of limited bone stock, due to osteolysis or initial femoral medullary canal compromise, especially if one or both implants are loose, TFR may be indicated as consolidation, is jeopardized by the uncertain mechanical situation.
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Orthop Traumatol Sur · Nov 2011
Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases.
A medial opening wedge high tibial osteotomy (HTO), where the osteotomy site is filled, is often preferred to a lateral closing osteotomy, but filling the defect can lead to certain complications. ⋯ Bone union seems to happen more slowly when the defect is filled; however, there are doubts about radiological evaluation of bone union in different published studies. When osteotomy defect was left unfilled in this study, union and filling of 4/5 of the osteotomy site was obtained in 4.2 months for 49 of the 51 cases. Fixation with the locking plate is reliable and provides stable correction and the option for early weight-bearing.