Uncemented modular stems used for Vancouver B2 and B3 periprosthetic femoral fractures
Bibliographic record
Abstract
Objective To evaluate the clinical outcome of Vancouver B2 and B3 periprosthetic femoral fractures treated with uncemented modular stems. Methods From September 2011 to April 2014, Twenty-four patients (12 males and 12 females, with the average age 63 years, ranging from 28 to 85 years) with periprosthetic femoral fractures (16 Vancouver B2 and 8 Vancouver B3) were treated with uncemented modular stems. Revision arthroplasty was conducted in all cases by using modular stems with 12 cerclage wirings and 11 great trochanter claw plates. One patient was treated with revision arthroplasty without additional fixations. Extended trochanter osteotomy was performed on 11 patients. Cortical strut allograft was used in 9 patients with severe femoral bone loss. Intraoperative complications including vascular or nerve injury and systemic complications including cardiovascular events, cerebrovascular events and deep vein thrombosis were recorded. Severe postoperative complications such as nonunion, re-fracture, periprosthetic joint infection and dislocation were recorded. The clinical outcome was evaluated by Harris score, Visual Analogue Score and Parker Mobility Score. The radiological outcome was taken to observe the healing status, stem subsidence and stability of the prosthesis. Results Two patients were lost to follow-up. Twenty-two patients were clinically followed-up. Radiological data was recorded in 16 patients. The average follow-up was 33 months (range, 12-68 months). All fractures healed within 6 months. The average Harris score improved from 4.0±1.1 preoperatively to 78.8±16.2 postoperatively (t= -20.195, P=0.000). The mean Parker Mobility Score improved from 0.5±0.9 preoperatively to 7.0±1.8 postoperatively (t=-14.835, P=0.000). The mean Visual Analogue Score decreased from 6.4±1.2 preoperatively to 2.0±1.5 postoperatively (t=10.879, P=0.000). No nonunion, infection or dislocation was found. One patient underwent re-operation because of re-fracture. Eight mm of prosthesis subsidence was observed in one case at 3 months postoperatively, and reached stable fixation at 6 months postoperatively without further subsidence. Conclusion Uncemented modular stems can achieve distal fixation and implant stability of periprosthetic femoral fractures while retaining optimal biomechanics of the hip. Assisted by femoral reconstruction techniques such as extended trochanter osteotomy, cortical strut allograft, great trochanter claw plates and cerclage wiring, revision arthroplasty using uncemented modular stems could realize optimal outcomes in treating Vancouver B2 and B3 periprosthetic femoral fractures. Key words: Arthroplasty, replacement, hip; Periprosthetic fractures; Femur; Reoperation; Prosthesis design
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".