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The Journal of Bone and Joint Surgery 79:1422-32 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - The Role of Allografts in the Treatment of Periprosthetic Femoral Fractures*{dagger}

HUGH P. CHANDLER, M.D.{ddagger} and RUSSELL G. TIGGES, M.D.§, BOSTON, MASSACHUSETTS

An Instructional Course Lecture, The American Academy of Orthopaedic Surgeons


   Introduction
 
Fracture of the femoral shaft occurring after total hip or total knee replacement is a rare but serious complication1-29,31-37,39-49,52-54. If the prosthesis is loose, the logical treatment is a revision operation with insertion of a femoral component with a longer stem to stabilize the fracture. If the stem is firmly fixed, the best method of treatment is more difficult to determine. The options available include closed treatment (traction or application of a spica cast or a cast-brace), exchange of the stem for a longer one that stabilizes the fracture, supracondylar nailing for a fracture proximal to a total knee prosthesis, and open reduction and internal fixation of the fracture.

Closed treatment of a fracture of the femoral shaft is associated with many problems3,5,11,14,15,20,25,29,31,35,48, including medical complications secondary to prolonged bed rest, potential loss of motion of the hip or knee, and non-union or malunion. Malunion is particularly troubling . . . [Full Text of this Article]


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