Fractures de type III : attitudes thérapeutiques, complications, résultats

Abstract

We reviewed 47 type 3 femoral fractures (below the femoral stem according to the Johansson classification). There were 36 women and 11 men. The average age was 73,4 years, at the time of the fracture.

These patients had had a total arthroplasty in 32 cases, a hemi arthroplasty in 10 cases and a bipolar arthroplasty in 5 cases.

Of these 47 patients:

- 6 underwent an orthopedic treatment (2 trans-tibial traction, and 4 plaster of Paris immobilisations) for a period averaging 60 days. Two (33%) developed pseudoarthritis and 2 (33%) developed bed-sores and decubitus complications.

- The remaining, 41 patients underwent a surgical procedure:

- 34 osteosynthesis using plates or screw plates brought about : - 4 fractures under the plate; - 4 pseudo-arthrosis; - 4 infections; - 4 plate breakages; - 1 femoral stem loose-ring;- 6 femoral stems were replaced with longer stems going through and extending past the fractures, without any material breakage or local complications (one patient died however, following other complications).

- One patient had an Olerud procedure and unfortunately died after 3 months.

At last follow up : - 4 patients had died; - consolidation occured in 41 cases over an average period of 130 days (45 to 590); - fractures treated by using osteosynthesis plates, showed a 50% incidence of complication; - on the other hand, when using stem replacement, no mechanical or local complications occured.

Résumé

La série comprend 47 fractures de type III dans la classification de Johansson, dont 36 femmes et 11 hommes d’âge moyen 73,4 ans. 6 furent traités orthopédiquement avec 66 % de complications. 34 ostéosynthèses ont donné un taux de complications de 50 %, alors qu’il n’y a eu aucune complication mécanique pour les 6 patients traités par reconstruction prothétique.