Peri prosthetic fracture
Introduction
Peri prosthetic fracture is a fracture that occurs near a joint replacement like knee replacement, hip replacement, etc. When the bone near or around the artificial joint breaks it is termed as peri prosthetic fracture, mostly seen in hip, knee and shoulder joint.
Peri prosthetic fracture usually requires surgical treatment.
Causes
Domestic fall :
fall in bathroom, stairs or while walking in home.
Direct injury :
injury on the site of replaced joint.
Weak muscles :
replaced joint with less muscle strength.
Neurological illness :
problem or illnesses related to the nerves.
Weak bones :
presence of conditions like osteoporosis causes bones to weaken.
Poor balance / gait / higher function disorders of brain :
age related degeneration causing deterioration of the brain function
Symptoms (What are patients’ complaints ?) :
The symptoms associated with peri prosthetic fracture are :
- Patient complains of pain near or around the joint.
- Patient has swelling around the affected site.
- Patient’s fractured limb appears small / shorter.
- Patient is unable to perform movement with the affected limb.
- Patient may have deformity.
Diagnosis :
- X-ray helps in confirming the diagnosis of peri prosthetic fracture by giving a proper image of the affected site.
- Some cases requires a CT scan for diagnosis and further plan of the treatment of peri prosthetic fractures.
Treatment :
- Type of fracture, the number of fragments the bone pieces are broken into helps to decide the treatment plan.
- Location of fracture may be near the replacement.
- Medical health of the patient i.e., presence of high blood pressure or diabetes.
- Bone pathology (diseases) like osteoporosis, renal osteodystrophy causes the weakening of bones.
- Presence of soft tissue injury i.e., injury to the skin and muscles near and around the joint.
Conservative Treatment :
- Undisplaced (hairline crack) and stable (on clinical examination) peri prosthetic fractures can be treated by plaster, brace or splint.
- It is advisable to take weekly X-rays to review the position and alignment of the healing fracture.
Operative Treatment :
- All displaced peri prosthetic fractures require surgery.
- To treat displaced peri prosthetic fracture the fracture site is exposed, bones are set in perfect position and nail/ plates is fixed to stabilize the fracture.
Post-operative care (After surgery care) :
After surgery of the peri prosthetic fractures, early movement of the adjacent joint is encouraged to avoid stiffness and improve local circulation and reduce swelling and enhance bone healing.
Ice packs, pain medications are given for pain relief.
Results :
Complications :
- Presence of weak bones due to old age or bone diseases.
- Poor blood supply to the bone due to fracture.
- Higher chances of infection.
- Presence of certain medical conditions like diabetes delays the healing process.
- Infection
- Joint stiffness in the adjacent joint
- Absence of healing of the fractured bone – non union
- Bone heals in altered alignment – mal union