Tratamiento de las fracturas periprotésicas de fémur Vancouver B2 y B3

• Autores: Germán Garabano, Cesar Pesciallo, Gabriel Nazur, Damian Arroquy, Hernan del Sel
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 77, Nº. 4, 2012, págs. 252-259
• Idioma: español
• DOI: 10.15417/37
• Títulos paralelos:
  • Treatment of Vancouver B2 and B3 periprosthetic fractures of the femur.
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• Resumen
  • español

    IntroducciónLas fracturas periprotésicas femorales luego de un reemplazo total de cadera son cada vez más prevalentes. Cuando estas asientan sobre un tallo flojo (B2) o con déficit de capital óseo (B3), según la clasificación de Vancouver, el tratamiento es la revisión del tallo femoral.Material y métodosSe analizó retrospectivamente a 22 pacientes, 9 fracturas tipo B2 y 13 tipo B3 de la clasificación de Vancouver. El promedio del seguimiento fue de 48 meses. Se utilizaron tallos largos cementados junto con aloinjerto óseo impactado, tablas corticales, tallos largos no cementados de fijación distal y endoprótesis no convencionales, según el caso.ResultadosSe observó la curación y la remodelación de la fractura en todos los pacientes. Las complicaciones fueron 2 (9%) luxaciones, 1 (4,5%) infección, 1 (4,5%) fractura de calcar, 1 (4,5%) aflojamiento de cotilo y 2 (9%) decesos.ConclusionesLas fracturas posoperatorias periprotésicas de fémur tipo B2 y B3 requieren recambio del tallo femoral, si bien existe una tendencia actual a utilizar tallos no cementados, en esta serie, dada la superposición de tratamientos, según cada subtipo de fractura, no obtuvimos diferencias entre el uso de tallos cementados junto con injerto y tallos no cementados. En casos de grave déficit de capital óseo, las endoprótesis no convencionales ofrecen una opción terapéutica para pacientes con baja demanda funcional. La clasificación de Vancouver es un instrumento útil para evaluar y decidir el tratamiento.

  • English

    BackgroundPeriprosthetic fractures of the femur are becoming more prevalent. When this fracture occurs in a loose stem (B2) or with bone loss (B3), the treatment is femoral stem revision.MethodsWe analyzed retrospectively 22 patients, 9 with type B2 fractures and 13 with type B3 fractures of the Vancouver classification. Follow-up averaged 48 months. We used cemented long stems, with impacted bone allograft, strut allograft, uncemented long stems (with distal fixation) and unconventional endoprosthesis according to the case.ResultsAll fractures healed and remodeled. The complications were 2 (9%) dislocations, 1 (4.5%) infection, 1 (4.5%) calcar fracture, 1 (4.5%) loosening of cemented acetabular component and 2 (9%) deaths.Conclusions The periprosthetic femoral fractures B2 and B3 require replacement of the femoral stem, while there is a trend to use uncemented stems; in this series due to the overlap of treatments according to each subtype of fracture, there were no differences between the use of cemented stems with allograft or uncemented stem. In cases of severe bone loss the unconventional endoprosthesis offer a treatment option for patients with low functional demand. The Vancouver classification is a useful tool to guide the surgeon on the treatment.

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