We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a ...We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a cemented revision stem placed using the cement-within-cement technique combined with an extended trochanteric osteotomy(ETO).A second revision was subsequently performed using a cortical window osteotomy and a distally fixed uncemented stem,which resulted in successful recovery.A similar approach was used to treat a subsequent contralateral stem fracture,also with favorable outcomes.This case emphasizes three key considerations:First,that standard-length cemented stems may lead to oversizing and increased stress concentration in Dorr A femurs with narrow canals;second,that ETO may compromise femoral integrity and contribute to implant failure;and third,that cortical window osteotomy enables safer implant removal and reimplantation.Based on these findings,we advocate for an individualized approach to implant selection that may include cemented short stems,uncemented short stems,or modular solutions depending on femoral anatomy and patient-specific factors,and we encourage further investigation into optimal fixation strategies for patients with Dorr A femoral morphology.展开更多
BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery.Although there have been few reports of femoral component fracture,removal of a broken femoral stem can be ...BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery.Although there have been few reports of femoral component fracture,removal of a broken femoral stem can be a challenging procedure.CASE SUMMARY A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem,two years after receiving a revision using a cement-within-cement technique(CWC)through an extended trochanteric osteotomy(ETO).The technical problems related to the CWC technique and the ETO played a major role in the stem fatigue refracture.We performed revision surgery and removed the distal cement using a cortical femoral window technique,followed by reimplantation with an uncemented,modular,distally-fixed uncemented stem.The patient experienced an uneventful postoperative recovery.CONCLUSION Re-fracture of a modern femoral ExeterTM stem is a rare event,but technical complications related to revision surgery can lead to this outcome.The cortical window osteotomy technique can facilitate the removal of a broken stem and cement,allowing for prosthetic reimplantation under direct vision and avoiding ETO-related complications.展开更多
We are delighted to be able to introduce this second special issue of the Fudan Journal of the Humanities and Social Sciences, on behalf of the University of Exeter, the College of Humanities, and the Departments of M...We are delighted to be able to introduce this second special issue of the Fudan Journal of the Humanities and Social Sciences, on behalf of the University of Exeter, the College of Humanities, and the Departments of Modern Languages and English. This special issue selects articles revised from papers delivered at the inaugural Fudan-Exeter Colloquium, ＇Reading across Cultures： Global Configurations of Reception, Adaptation and Transmission＇, held at Fudan University, Shanghai, from 23 to 25 June 2014, and further articles developed from collaborative discussions between Fudan and Exeter colleagues around this central set of concerns.展开更多
文摘We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a cemented revision stem placed using the cement-within-cement technique combined with an extended trochanteric osteotomy(ETO).A second revision was subsequently performed using a cortical window osteotomy and a distally fixed uncemented stem,which resulted in successful recovery.A similar approach was used to treat a subsequent contralateral stem fracture,also with favorable outcomes.This case emphasizes three key considerations:First,that standard-length cemented stems may lead to oversizing and increased stress concentration in Dorr A femurs with narrow canals;second,that ETO may compromise femoral integrity and contribute to implant failure;and third,that cortical window osteotomy enables safer implant removal and reimplantation.Based on these findings,we advocate for an individualized approach to implant selection that may include cemented short stems,uncemented short stems,or modular solutions depending on femoral anatomy and patient-specific factors,and we encourage further investigation into optimal fixation strategies for patients with Dorr A femoral morphology.
文摘BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery.Although there have been few reports of femoral component fracture,removal of a broken femoral stem can be a challenging procedure.CASE SUMMARY A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem,two years after receiving a revision using a cement-within-cement technique(CWC)through an extended trochanteric osteotomy(ETO).The technical problems related to the CWC technique and the ETO played a major role in the stem fatigue refracture.We performed revision surgery and removed the distal cement using a cortical femoral window technique,followed by reimplantation with an uncemented,modular,distally-fixed uncemented stem.The patient experienced an uneventful postoperative recovery.CONCLUSION Re-fracture of a modern femoral ExeterTM stem is a rare event,but technical complications related to revision surgery can lead to this outcome.The cortical window osteotomy technique can facilitate the removal of a broken stem and cement,allowing for prosthetic reimplantation under direct vision and avoiding ETO-related complications.
文摘We are delighted to be able to introduce this second special issue of the Fudan Journal of the Humanities and Social Sciences, on behalf of the University of Exeter, the College of Humanities, and the Departments of Modern Languages and English. This special issue selects articles revised from papers delivered at the inaugural Fudan-Exeter Colloquium, ＇Reading across Cultures： Global Configurations of Reception, Adaptation and Transmission＇, held at Fudan University, Shanghai, from 23 to 25 June 2014, and further articles developed from collaborative discussions between Fudan and Exeter colleagues around this central set of concerns.
