Evidence map›Paper›PMID 34992896›Full record

ArticleGeriatric orthopaedic surgery & rehabilitation2021

Combined Surgical and Medical Treatment for Vancouver B1 and C Periprosthetic Femoral Fractures: A Proposal of a Therapeutic Algorithm While Retaining the Original Stable Stem.

Nicola Mondanelli, Elisa Troiano, Andrea Facchini, Martina Cesari, Giovanni Battista Colasanti, Vanna Bottai, Francesco Muratori, Carla Caffarelli, Stefano Gonnelli, Stefano Giannotti

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Geriatric orthopaedic surgery & rehabilitation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.7field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 9 citations in OpenAlex.

  1. Review
  2. Article
  3. Article
  4. Treatment Algorithm of Periprosthetic Femoral Fracturens.Geriatric orthopaedic surgery & rehabilitation · 2022
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Nicola MondanelliDepartment of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.ORCID https://orcid.org/0000-0002-0684-4197
Elisa TroianoDepartment of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.
Andrea FacchiniDepartment of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.
Martina CesariDepartment of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.
Giovanni Battista ColasantiAzienda USL della Romagna, Ospedale Santa Maria delle Croci, Ravenna, Italy.
Vanna BottaiSecond Clinic of Orthopedic and Traumatology, University of Pisa, Pisa, Italy.
Francesco MuratoriSection of Orthopedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
Carla CaffarelliDepartment of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.
Stefano GonnelliDepartment of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.
Stefano GiannottiDepartment of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.
University of Siena · ITAzienda Ospedaliero-Universitaria Careggi · ITAzienda Unità Sanitaria Locale Della Romagna · ITUniversity of Pisa · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThere is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Evidence exists that some patterns of fracture around a stable stem are better treated with revision surgery than with standard fixation. Anyway, a more aggressive surgical procedure together with medical treatment could allow for stem retention, and reduced risk of nonunion/hardware failure, even in these cases. SIGNIFICANCE: This paper is placed in a broader context of lack of studies on the matter, and its aim is to shed some light on the management of PFFs around a stable stem, when peculiar mechanical and biological aspects are present.

resultsBased on our casuistry in the treatment of nonunions after PFF successfully treated with original stem retention, and on review of Literature about risk factors for fixation failure, an algorithm is proposed that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem, without resorting to revision. Mechanical (major and minor) and biological (local and systemic) factors that may influence fracture healing, leading to nonunion and hardware failure, and subsequent need for re-operation, are considered. The proposed surgical technique consists of rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous bone marrow concentrate over a platelet-rich plasma-based scaffold) at fracture site. Systemic anabolic treatment (Teriparatide) is also administered in the post-operative period.

conclusionMechanical factors are not the only issues to be considered when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions should be taken into account, as well. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, considering mechanical and biological criteria.

Indexed as

Adult reconstructive surgeryfragility fracturegeriatric traumaosteoporosisperiprosthetic fracturestable stemTeriparatidetrauma surgery

Identifiers

PMID34992896
PMCPMC8725223
OpenAlexW4206316304

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.