Management of Clamshell Fractures in Total Hip Arthroplasty: A Rarely Recognized Periprosthetic Injury Pattern

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Periprosthetic femoral fractures (PPFFs) are the third leading cause for revision total hip arthroplasty (THA).
• The incidence of PPFFs is rising due to the increasing number of primary hip replacements.
• Clamshell fractures (CFs) are an underrecognized and controversial PPFF pattern often omitted from classifications.

Purpose of the Study:

• To provide a comprehensive overview of clamshell fractures as a distinct periprosthetic injury pattern.
• To outline and discuss treatment options for CFs based on biomechanical considerations.
• To address the limited current literature and poorly defined standardized therapeutic approaches for CFs.

Main Methods:

• Literature review focusing on periprosthetic femoral fractures and clamshell fractures.
• Analysis of biomechanical principles relevant to fracture treatment.
• Discussion of current therapeutic options and their limitations.

Main Results:

• Clamshell fractures represent a significant and underestimated pattern of periprosthetic injury.
• Treatment strategies for CFs are diverse, depending on patient factors and stem stability.
• Standardized therapeutic approaches for CFs are not well-defined in existing literature.

Conclusions:

• Clamshell fractures require specific attention within the spectrum of periprosthetic femoral fractures.
• Further research and standardized guidelines are needed for optimal management of CFs.
• Biomechanical considerations are crucial for selecting appropriate treatment for CFs.