Cement Mantle Screws in Periprosthetic Hip Fracture Fixation Near Well-Fixed Femoral Stems May Not Impact Short-Term Femoral Stem Survivorship
Bibliographic record
Abstract
BACKGROUND: Vancouver Type-B1 and C periprosthetic hip fractures have traditionally been treated using single- or double-plate fixation constructs. Concern exists regarding screws within the cement mantle due to the theoretical risk of cement fracture and eventual prosthetic loosening. The aim of this study was to assess femoral stem survivorship in patients with Vancouver Type-B1 or C fractures around a well-fixed cemented femoral component who were treated with a plate construct and screws into the cement mantle. The hypothesis was that screw fixation into the cement mantle would not compromise stem fixation. METHODS: A retrospective review was performed of patients who were consecutively, surgically treated for a periprosthetic fracture around a femoral stem by 3 surgeons, as identified through a search of records from January 1, 2007, to January 1, 2023. A total of 112 consecutive patients with Vancouver Type-B1 or C periprosthetic femoral fractures treated at our institutions were reviewed. Patients who underwent fixation using plate constructs with ≥1 screw within the cement mantle around the stem were included. Patients were followed until union, revision due to plate construct failure, or stem revision. Other complications, including alignment loss, cemented stem subsidence, radiographic stem loosening, and new cement-mantle fractures, were assessed. RESULTS: Twenty-eight patients (19 female; 27 White or Caucasian; 3 Hispanic or Latino; mean age, 81.4 ± 8.7 years) met the inclusion criteria. Radiographic union was achieved in 26 patients (92.9%). The study included 8 (28.6%) interprosthetic fractures between a total hip arthroplasty prosthesis and a total knee arthroplasty prosthesis. The mean union time was 8.0 ± 4.6 months (range, 2.2 to 25.6 weeks). The mean follow-up duration following the index procedure was 33.3 ± 24.0 months (range, 6.1 to 86.2 months). Two nonunions occurred (7.1%), both involving plate failure. Both patients required revision of the femoral prosthesis, which was not loose at the time of reoperation. No stem subsidence or cement mantle fractures occurred during follow-up, and no revisions were performed for stem loosening. CONCLUSIONS: Screw fixation into cement around a well-fixed stem did not contribute to stem loosening at short-term follow-up. There were no isolated femoral component revisions for cement mantle issues. LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 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) | 0.002 | 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 source (direct Gemma or distilled Codex), 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".