PubMed1996
PURPOSE OF THE STUDY: This study was performed to analyse the clinical and radiological results obtained after the treatment of femoral fractures after total hip arthroplasties by a Charnley's extra long-stem prosthesis, and to compare these results with those obtained by alternative treatments proposed by various authors. MATERIALS: 18 patients, whose mean age was 68.5 years (extremes: 45 to 86 years). Cooke and Newman fractures classification showed a clear prominence of type III. In 8 cases we found a femoral loosening, prior to the fracture, divided as follows: 4 in grade III and 4 in grade IV, using Vives classification. Type I fractures were always associated to complete femoral loosening. METHOD: Clinical results were analysed by Merle d'Aubigné's scoring system, giving a pre-fracture global score of 13.5. Post-operative radiological analysis was made on the appearance of femoral radiolucent lines and/or modification of the femoral implant. RESULTS: 17 patients were followed, with a mean of 5 years (extremes: 1 to 14 years). Consolidation was always obtained. The global mean functional results were of 15.2, with score improvement, essentially, of soreness and stability. We found 12 good and very good results, 4 poor and 1 bad. Age (< 75 years) and fracture type (II and III) appeared to be important factors influencing the functional result, contrary to the lesional mechanism. 6 non-evolutive bone-cement radiolucent lines appeared, in immediate post-operative phase. One cement-prosthesis radiolucent line appeared later, leading to loosening and rupture of the implant. We deplore 3 stem twistings, of which only one led to implant rupture. Walking with support was possible at the 5th postoperative days. DISCUSSION: Our functional results are encouraging (12 good results, i.e. 71 per cent), compared with other treatments. This technique improved the global functional score. This is due to the simultaneous treatment of the fracture and of the eventual pre-traumatic associated femoral loosening. The technique allows a quick resumption of autonomy, a short hospitalization time for these elderly patients. The main disadvantage of the orthopaedic treatment is the prolonged decubitus and the important risk of secondary loosening. Osteosynthesis by plate has the advantage of keeping a maximum of osseous stock, but delays weight bearing, favours the non union by a large loss of periosteum. It never permits the treatment of the associated loosening during the same operation. It is also at the origin of a cement weakening, while fixing the proximal screws, leading to the difficulty of placing the prosthesis. Major disadvantage of proposed method is the use of a high quantity of cement to ensure stability of the implants; but this has never had negative consequences in our study. CONCLUSION: This surgical technique seems to be a satisfying alternative to the treatment of femoral fractures on total hip arthroplasty, due to the advantages obtained. It is reserved for elderly patients. However, these findings should be taken with caution, due to our small series.