Management of periprosthetic proximal femoral fracture of megaprosthesis with limited residual bone stock: A case report
Bibliographic record
Abstract
Periprosthetic fractures involving femoral megaprostheses are complex and challenging to manage due to limited residual bone stock available for fixation. In Indonesia, data on such complications are scarce, and surgical strategies often require adaptation based on resource availability. A 42-year-old man with a history of distal femoral megaprosthesis implantation for a giant cell tumor presented with right hip pain after a low-energy fall. Imaging showed a Vancouver type B3 periprosthetic fracture. The remaining proximal femoral bone stock measured only 7.5 cm, significantly limiting options for internal fixation due to poor surface area and compromised load distribution. Surgical management involved internal fixation using a trochanteric claw plate and cable wires. Dual 8 cm autologous fibular strut grafts were harvested and positioned anteriorly and posteriorly around the fracture site. Postoperative recovery was uneventful. At four-month follow-up, the patient demonstrated excellent progress, with no signs of infection, good range of motion, and absence of pain. This case illustrates the viability of using a trochanteric claw plate and fibular strut grafts to treat periprosthetic fractures around a stable femoral megaprosthesis. The fracture likely occurred due to bone fragility at the cement–bone interface. The combination of mechanical fixation and biological grafting enabled early mobilization while preserving the existing implant. In resource-limited settings, this technique offers a promising limb-salvage strategy with favorable short-term outcomes. Further studies are needed to validate long-term effectiveness. • This case demonstrates a successful limb-salvage technique for managing a periprosthetic femoral fracture around a stable megaprosthesis with severely limited residual bone stock. • A combination of trochanteric claw plate fixation and dual autologous fibular strut grafts provided both mechanical stability and biological support. • The approach is practical and reproducible, offering a viable solution for resource-limited settings with favorable short-term outcomes.
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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 | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| 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) | 0.000 | 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".