Is internal fixation alone advantageous in selected B2 periprosthetic fractures?

BACKGROUND: Revision surgery is currently the recommended treatment for Vancouver B2 femoral periprosthetic fractures, but isolated open reduction and internal fixation (ORIF) might be an effective treatment for these fractures around cemented collarless polished tapered (CCPT) stems, as these stems can re-engage in the cement mantle, regaining stability following internal fixation. The aim of this study was to determine the operative risks, post-operative complications, and radiographic and functional outcomes in two cohorts of Vancouver B2 femoral fractures around CCPT stems treated either by ORIF alone or revision surgery. METHODS: The results of 12 patients with B2 periprosthetic fractures around a CCPT stems treated by ORIF alone (median follow-up 67 months) were compared with those of nine patients with a similar fracture treated by revision surgery (median follow-up 59 months). RESULTS: All fractures treated by ORIF alone healed and all stems restabilized and remained stable within their original cement mantle. These patients had significantly shorter overall operating room times (P = 0.002), surgical times (P = 0.002) and required fewer units of blood transfusion (P = 0.008) than patients in the revision cohort. In the ORIF cohort, one patient had two dislocations. In the revision cohort, one patient had delayed wound healing, a second patient had delayed wound healing and two dislocations, and a third patient had two dislocations. CONCLUSION: Although further studies with larger numbers are required, treatment of these fractures with ORIF alone may be a viable alternative to revision surgery as it reduces the operative risks involved.

Spontaneous spinal epidural hematoma: a case report and literature review.

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare cause of spinal cord compression that requires emergency investigation and treatment. Prompt diagnosis is essential to prevent morbidity and mortality. OBJECTIVES: Our goal was to report a case of SSEH, and to review the literature on the topic, looking particularly at the factors influencing post-operative outcome, and the symptoms and signs that would lead one to consider this rare diagnosis. CASE REPORT: A 36-year-old man presented to the Emergency Department with paraplegia and a sensory level at T4. There was no history of trauma and he was not taking any medications. Magnetic resonance imaging revealed a large non-enhancing posterior epidural mass lesion between C7 and upper T4, causing severe cord compression at T1-T3. Post contrast scans revealed no rim enhancement. Blood investigations were unremarkable, with an international normalized ratio of 1.1. He underwent urgent decompression laminectomy within 12 h of symptom onset. Intraoperatively, thick clotted blood and prominent epidural vessels were seen. Histology revealed engorged vessels with hemorrhage and clot in the extravascular tissues. Post-operatively, the impaired neurological status remained unchanged. CONCLUSION: SSEH is a rare cause of spinal cord compression that requires prompt diagnosis and surgical intervention to prevent morbidity. Neurological outcome after surgical decompression depends on the severity of preoperative neurological deficits as well as the time between symptom onset and surgery.

Unusual appearances following intracapsular neck of femur fractures.

PURPOSE: The aim of the study was to investigate the possible outcomes of intracapsular femoral neck fractures managed non-operatively or with a simple form of internal fixation. METHODS: We reviewed 30 fractures and their post mortem reports from the Galler collection, a modern pathology reference series. RESULTS: Our investigation revealed unusual appearances of the hip following femoral neck fractures that are not usually seen in modern orthopaedic practice, including previously undescribed acetabularisation of the femur and ankyloses of ununited femoral heads. CONCLUSION: Appreciation of these appearances and an understanding of how these fractures may progress are important in the current diagnosis and management of delayed presentations, neglected or inadequately fixed subcapital fractures of the femoral neck.