OKOJ, Volume 12, No. 1

In recent years, there has been a dramatic increase in the number of elderly patients who present with an acetabular fracture. The combination of advanced age and the osteoporosis inherently present in elderly patients predisposes to acetabular fracture comminution and articular impaction, both of which have been identified as risk factors for poor outcomes with open reduction and internal fixation. Given the relatively poor results with this treatment modality and the comorbidities often present in this patient population, alternative treatment methods are important. No consensus about the optimal management of acetabular fractures in elderly patients has been established; therefore, individualization of treatment is important. Treatment alternatives include nonsurgical treatment with mobilization, traction with or without delayed total hip arthroplasty, femoral head resection with or without delayed hip arthroplasty, limited percutaneous fixation, and acute total hip arthroplasty.

Periprosthetic fractures of the femur after total hip arthroplasty represent a challenging problem of increasing frequency, whose treatment is often complicated by osteopenic bone around the femoral component of the implant. These fractures are classified and commonly treated according to the Vancouver classification system. This article reviews the presentation, classification, and management of periprosthetic fractures of the femur in patients with a total hip arthroplasty. In particular, we focus on the surgical technique for managing Vancouver type B1 fractures, which occur at or just distal to the tip of the femoral stem of the prosthesis and are associated with a stable implant.

The number of periprosthetic fractures in patients with orthopaedic implants is increasing. Surgeons need a variety of techniques to manage such fractures and a potentially unstable implant. Strut grafts of cortical bone are useful in treating periprosthetic fractures of the femur. Plate fixation with screws and cables or wires is also used, as is revision of the prosthesis if required, depending upon the location of the fracture and stability of the implant. Because of this, orthopaedic surgeons need to be familiar with indications for the use of allograft bone as well as with its biomechanics and biology. The treatment of periprosthetic fractures requires a multidisciplinary approach and a careful preoperative surgical plan. With this, and with the other requirements named here, studies have found consistently good results in the management of periprosthetic fractures, with a reduced incidence of nonunion in most series of patients.

The lateral ankle joint has a complex osseous anatomy, thus anatomic reduction of fractures is essential to lowering the risk of posttraumatic arthritis due to abnormal loading of cartilage on the articular surfaces. In elderly and other at-risk patients, bone quality in the distal fibular metaphysis is often poor, compounded by osteoporosis. For this reason, it is important for the treating surgeon to consider methods of fixation that will maximize the stability of anatomic reduction and minimize complications. This article reviews the principles of and indications for locked plating in the treatment of skeletal fractures, and examines the effectiveness of locked plating in the treatment of distal fibula fractures from a biomechanical and a clinical perspective.