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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...

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Multidisciplinary Approach to a Transverse Periprosthetic Femur Fracture in a Short-Statured Patient: A Case Report.

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Periprosthetic femur fractures (PFFs) in patients with VACTERL syndrome and metabolic bone disease can experience delayed healing. This case highlights successful union with dual-plate fixation, bone grafting, and targeted medical therapy.

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Area of Science:

  • Orthopedic Surgery
  • Metabolic Bone Disease
  • Fracture Healing

Background:

  • Periprosthetic femur fractures (PFFs) are complex complications following total hip arthroplasty.
  • Patients with underlying metabolic bone disorders present unique challenges for fracture management and healing.
  • Vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula, esophageal atresia, renal anomalies, and limb abnormalities (VACTERL) syndrome can be associated with metabolic bone issues.

Purpose of the Study:

  • To report a case of a Vancouver B1 PFF in a patient with VACTERL syndrome.
  • To describe the management and prolonged healing process of a complex PFF.
  • To emphasize the role of advanced fixation techniques and multidisciplinary care in managing delayed fracture union.

Main Methods:

  • A 43-year-old female with VACTERL syndrome sustained a Vancouver B1 PFF after revision total hip arthroplasty.
  • Initial treatment involved open reduction and internal fixation (ORIF) with dual plate fixation.
  • Subsequent treatment included abaloparatide administration and autologous iliac crest bone grafting 10 months post-ORIF.

Main Results:

  • Radiographic union of the PFF was achieved 2 years after the initial ORIF procedure.
  • The patient's complex fracture required a prolonged healing period, characteristic of metabolic bone disease.
  • The combination of surgical fixation and medical management facilitated eventual bone healing.

Conclusions:

  • Periprosthetic femur fractures in patients with metabolic bone disease, such as VACTERL syndrome, often necessitate extended healing times.
  • Dual-implant fixation provides robust stability for complex PFFs.
  • A multidisciplinary approach addressing both the fracture and the underlying metabolic bone disorder is crucial for successful treatment outcomes.