Wiki Periprosthetic fracture with ORIF

[adamsc]

is this 27236? the fracture is in the shaft

POSTOPERATIVE DIAGNOSIS: Right hip periprosthetic fracture. PROCEDURE PERFORMED: 1. Right total hip arthroplasty revision. 2. Open reduction and internal fixation, right femur. IMPLANTS USED: 1. Stryker MDM liner to fit 54 mm cup. 2. Stryker restoration modular cone/conical construct with 15 x 155 conical stem and 23+0 proximal body. 3. A 28 mm Biolox +4 femoral head with X3 outer MDM femoral head. 4. Dall-Miles vitallium cables times 2. COMPLICATIONS: None. INDICATIONS FOR PROCEDURE: The patient is a pleasant 72-year-old gentleman who had right total hip arthroplasty performed on 06/10. Recovery was uneventful for the first couple weeks, then he started having increasing pain. Serial radiographs at Spencer revealed a nondisplaced periprosthetic fracture. CT scan showed the spiral extending to the stem tip. We reviewed the relative risks, benefits, potential complications, and alternatives to surgery. We discussed specifically conservative management versus operative repair. Given his size and inability to protect weightbearing to the right lower extremity, we elected to proceed with operative intervention. DESCRIPTION OF PROCEDURE: After the patient was correctly identified in the preoperative holding, he was taken to the operating suite. Satisfactory general anesthesia was administered. Foley catheter placed. Placed in left lateral decubitus position on a well-padded pegboard with an axillary roll. Surgical timeout was performed after antibiotics and tranexamic acid given within 1 hour of surgery start. Surgery began with an elliptical incision, removing the previous surgical scar. Sharp dissection was carried down to the gluteal fascia. This was divided with the Bovie in line with the previous repair. Blunt dissection was performed down to the short external rotators. Piriformis remained intact. Conjoint tendon was healed back to its insertion. This was taken down and tagged with #5 Ethibond. The capsular repair was intact and capsulotomy was remade. Deep retractor was placed. Healthy-appearing joint fluid encountered. Attention was then turned distally, where an incision made in line with the femur was performed. Sharp dissection carried down to the IT band. This was then incised and deep retractors placed. Off the posterior border of the vastus lateralis, a blunt dissection was performed. A single cable was passed around the femur just proximal to the lesser trochanter. One was placed more distal towards the end of the fracture. These were provisionally tightened and held in place. Attention was turned back up to the hip joint. The hip was gently dislocated. Femoral head disimpacted. The extractor awl was used to remove the femoral stem. The wound was copiously irrigated. The polyethylene was then atraumatically removed from the locking mechanism using a screw technique. The shell was inspected and found to be well fixed. MDM liner was opened and impacted into place. The two Dall-Miles cables were then successfully tensioned, crimped and cut. Reaming of the femoral canal up to a size 15 mm satisfactorily met the patient's anatomy. A conical stem was then opened and impacted into place. The proximal body was then prepared up to 23 mm. Trialing with that revealed the hip to be stable throughout an aggressive arc of motion. Final proximal body was opened and impacted into place and tensioned. A +4 neck was assembled in MDM and impacted onto the trunnion. The hip was once more reduced, put through a stable arc of motion. The hip was irrigated with chlorhexidine, followed by normal saline. Vancomycin powder was sprinkled in the wound. The capsule was repaired anatomically. The piriformis remained intact throughout the case. The conjoined tendon had started to fray and was it was elected not to be repaired. It was not robust enough to hold the stitch. The remainder of the wound was closed in regular layered fashion. The distal wound was closed with interrupted Vicryl and 3-0 Monocryl running. The proximal wound was closed with interrupted Vicryl and interrupted nylon. Sterile dressing was applied. The patient was successfully extubated and returned to the recovery room in satisfactory condition, having tolerated the procedure without complication.

 

[Orthocoderpgu]

Correct. 27236.