PMC6664517_01
AP view of left hip injury radiographs showing periprosthetic femur fracture with evidence of a potential stress riser at the distal DHS/bone junction, with a significant amount of bony overgrowth of the DHS.
CRIOR2019-6814375.001.jpg
PMC6664517_01_CRIOR2019-6814375.001.jpg
fig1
Close inspection of imaging at the time of repeat injury showed evidence of a potential stress riser at the distal DHS/bone junction, with a significant amount of bony overgrowth of the DHS (Figure 1).
AP view of bilateral proximal femurs taken years prior to injury, showing evidence of stress shielding with significant bony overgrowth of the DHS.
CRIOR2019-6814375.002.jpg
PMC6664517_01_CRIOR2019-6814375.002.jpg
fig2
Additionally, there was evidence of stress shielding with significant cortical thickening involving the entire lateral cortex seen on radiographs taken prior to injury (Figure 2).
Intraoperative images of the left femur showing extensive bony overgrowth of the implant.
CRIOR2019-6814375.003.jpg
PMC6664517_01_CRIOR2019-6814375.003.jpg
fig3
Gross intraoperative inspection showed extensive bony overgrowth of the implant (Figure 3).
Intraoperative images of the left femur after removal of bony overgrowth and lateral plate with osteotomies. The hip screw is still in place.
CRIOR2019-6814375.004.jpg
PMC6664517_01_CRIOR2019-6814375.004.jpg
fig4
Osteotomies were utilized to remove the bony overgrowth to extract the hardware (Figures 4 and 5).
Intraoperative C-arm image of the left femur following implant removal. Notice the thin lateral cortex.
CRIOR2019-6814375.005.jpg
PMC6664517_01_CRIOR2019-6814375.005.jpg
fig5
Osteotomies were utilized to remove the bony overgrowth to extract the hardware (Figures 4 and 5).
(a-c) Intraoperative C-arm images of the left femur demonstrating a long-reamed cephalomedullary nail with distal interlocking screws.
CRIOR2019-6814375.006.jpg
PMC6664517_01_CRIOR2019-6814375.006.jpg
fig6
After successful removal of the previous sliding hip screw, the fracture was exposed, reduced, and a long reamed cephalomedullary nail was placed with distal interlocking screws without difficulty (Figures 6(a)-6(c)).
(a and b) Postoperative radiographs showing a healing fracture with abundant callus along the cortex.
CRIOR2019-6814375.007.jpg
PMC6664517_01_CRIOR2019-6814375.007.jpg
fig7
At subsequent postoperative follow-up visits, radiographic imaging revealed complete union of the previous fracture with an abundant amount of bridging callus (Figures 7(a) and 7(b)).