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Unfavorable cortical hypertrophy potentially predisposes to periprosthetic “axe splitter” fracture in a collarless polished curved triple-tapered cemented stem: The time-dependent radiographic change in five SC-stem cases
Journal of Orthopaedic Science ( IF 1.7 ) Pub Date : 2022-09-29 , DOI: 10.1016/j.jos.2022.09.004
Hitoshi Wakama 1 , Yoshinori Okamoto 1 , Tomohiro Okayoshi 1 , Kuniaki Ikeda 1 , Junya Matsuyama 1 , Shuhei Otsuki 1 , Masashi Neo 1
Affiliation  

Background

The periprosthetic fracture of cemented polished tapered stems is occasionally called a “unique” or “axe splitter” fracture. However, there has been insufficient evidence regarding the association between the radiographic findings prior to incidence and this cumbersome fracture. To determine if there are any radiographic interpretations associated with this fracture pattern, we report the five SC-stem cases with total hip arthroplasty.

Methods

We investigate the patient characteristics and serial radiographs of five fracture cases and evaluate the time-dependent specific radiographical changes around the stem between pre-arthroplasty and fracture.

Results

Fractures developed at 3.5–6.4 years after surgery with low-grade injury or with no particular incentive. Femoral cortical hypertrophy at the distal medial side around the stem was observed in all cases before the development of fractures, at 2–6 years after primary surgery. The duration between cortical hypertrophy appearance to the development of fracture was 0.4–3.1 years.

Conclusions

The appearance of this zone-specific cortical hypertrophy might play a key role in the occurrence of periprosthetic fractures. Further studies with larger sample sizes should be conducted to elucidate this eccentric periprosthetic fracture.



中文翻译:

不利的皮质肥大可能导致无环抛光弯曲三锥形骨水泥柄假体周围“斧劈”骨折:五例 SC 柄病例中随时间变化的放射学变化

背景

骨水泥抛光锥形柄的假体周围骨折有时被称为“独特”或“斧劈”骨折。然而,没有足够的证据证明发病前的放射学检查结果与这种麻烦的骨折之间的关联。为了确定是否存在与这种骨折模式相关的放射学解释,我们报告了五例全髋关节置换术的 SC 干病例。

方法

我们调查了五例骨折病例的患者特征和系列X光片,并评估了关节置换术前和骨折之间茎周围随时间变化的特定X光片变化。

结果

骨折发生在术后 3.5-6.4 年,伴有轻度损伤或无特殊诱因。在骨折发生前、初次手术后 2-6 年,所有病例均观察到股骨柄周围远端内侧的股骨皮质肥大。皮质肥大出现到发生骨折之间的时间为0.4-3.1年。

结论

这种区域特异性皮质肥大的出现可能在假体周围骨折的发生中起关键作用。应进行更大样本量的进一步研究以阐明这种偏心假体周围骨折。

更新日期:2022-09-29
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