Treatment Results of a Periprosthetic Femoral Fracture Case Series: Treatment Method for Vancouver Type B2 Fractures Can Be Customized

BACKGROUND: Currently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon's experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series. METHODS: Eighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon's judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated. RESULTS: Thirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities. CONCLUSIONS: We suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient's hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.

Clinical characteristics of the associated histopathological findings in benign prostatic hyperplasia / 대한비뇨기과학회지

We studied on the correlation between the associated histopathological lesions in benign prostatic hyperplasia and the clinical findings in 283 patients. The patients were divided into 5 groups according to the Following associated histopathological lesions : Nonspecific inflammation (274 patients. 96.8%). Granulomatous inflammation (7 patients. 2.4%. including tuberculosis 2 patients). infarction (8 patients, 2.8%). dysplasia (10 patients, 3.5%) and occult cancer (9 patients. 3.2%). There was no significant difference among the groups in age. The duration of symptoms was shorter in the infarction and occult cancer group than the others. The degree of inflammatory lesions were not correlated with preoperative urinalysis findings. Irritative symptom score was high in the patient of severe inflammatory lesion (P<0.05). Acute urinary retention was more common in the infarction group (62.5%) than the non-infarction group (10.9%). Prostatic; dysplasia was more common and higher degree in the occult cancer group (33.3%) than no cancer group(2.5%). So more precise pathological examination are necessary when dysplasia. especially severe dyplasia, is present. In conclusion. most patients of the benign prostatic hyperplasia had some associated histopathologic abnormal lesions, so more careful histopathological examination is needed to understand the progression of the disease.

Urinary Schistosomiasis: A Case Report / 대한비뇨기과학회지

Urinary schistosomiasis(bilharziasis), caused by digenetic bloodfluke, is an endemic disease in Africa, Yemen, Saudi Arabia, Israel, Lebanon, Syria and Iran, but not in Korea. We report one case of urinary schistosomiasis in Korea, who worked in North Yemen, with the review of literatures.

True Hermaphroditism, 4 Cases Report / 대한비뇨기과학회지

True hermaphroditism is a very rare congenital anomaly, in which both an ovary and a testis or a gonad with the histologic features of both(ovotestis) is present. So the external and internal genital organs are abnormally differentiated. We report 4 cases of true hermaphroditism with the review of the literatures.