Femoral Fracture in Non-Cemented hip Arthroplasty

Park, Myung Sik; Hwang, Byung Yun; Kim, Ki Hwan; Kang, Han Soo

Abstract

The femoral fracture, occurred associated with the cemented hip arthroplasty, is well-known cornplication but the proximal femoral fractures of the noncemented hip arthroplasty, were occurred more than those. Among the 290 patients, who were treated by the noncemented hip arthroplasty from Dec. 1987 to April 1992, the 24 cases of the femoral fracture were experienced and the results were as follows: 1) of the 24 cases, the male was nine and the female was fifteen. The age distribution was mostly occurred between 41 and 60 years old and most fracture were developed in 1 1mm stem size. In revision cases, 225mm stem length (Wagner) was common. The locations of fracture were proximal 1/3 (type I: 19 cases), tip (type II; 1 case), distal 1/3 (type III; 1 case) and comminuted (type IV; 3 cases) by Johansson; siclassification. 2) The femoral fracture was mostly developed during the stem insertion and the fracture site in anatomical stem was only proximal femur. 3) 1n cases of revision, most of the fractures were occured on the anterior or lateral side of the femur. It was difficult to manage the fracture because of the severe osteoporosis and comminution. 4) As the problem of the operative technique, the fracture incidence can be decreased by accurate preoperative measurement and it must be cautious in the stem more than 225 mm length, which were used in revision case. 5) The circumferential wiring for proximal and plate & screws in middle and distal were done as the treatment of fracture and the results were all good, but stem tip fracture in osteoporotic patients was troublesome. We think that long plate(>8 holes) & both cortex purchase and bone graft are best methods so far.