Periprosthetic femoral fractures after hemiarthroplasty. An analysis of 17 cases | Revista Española de Cirugía Ortopédica y Traumatología (English Edition)

array:24 ["pii" => "S1988885615000553" "issn" => "19888856" "doi" => "10.1016/j.recote.2015.07.004" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "551" "copyright" => "SECOT" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:333-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 49 "formatos" => array:2 [ "HTML" => 45 "PDF" => 4 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1888441514002471" "issn" => "18884415" "doi" => "10.1016/j.recot.2014.11.002" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "551" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:333-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 399 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 239 "PDF" => 153 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Fracturas periprotésicas de fémur sobre hemiartroplastia. Análisis de una serie de 17 casos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "342" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Periprosthetic femoral fractures after hemiarthroplasty. An analysis of 17 cases" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figura 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1236 "Ancho" => 1500 "Tamanyo" => 159754 ] ] "descripcion" => array:1 [ "es" => "Caso 11. a) Fractura tipo C sobre hemiartroplastia isoelástica; b) control radiográfico postoperatorio a los 6 meses, con consolidación de la fractura; c) detalle de la prótesis, con signos de cotiloiditis. En todas las imágenes se observa que el vástago se había cementado cuando se implantó, más de 20 años antes de la fractura." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Suárez-Huerta, A. Roces-Fernández, R. Mencía-Barrio, J.A. Alonso-Barrio, L.R. Ramos-Pascua" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Suárez-Huerta" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Roces-Fernández" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Mencía-Barrio" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Alonso-Barrio" ] 4 => array:2 [ "nombre" => "L.R." "apellidos" => "Ramos-Pascua" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1988885615000553" "doi" => "10.1016/j.recote.2015.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000553?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441514002471?idApp=UINPBA00004N" "url" => "/18884415/0000005900000005/v1_201508080021/S1888441514002471/v1_201508080021/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1988885615000541" "issn" => "19888856" "doi" => "10.1016/j.recote.2015.07.003" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "550" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:343-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 78 "formatos" => array:2 [ "HTML" => 57 "PDF" => 21 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Prognostic factors of a satisfactory functional result in patients with unilateral amputations of the upper limb above the wrist that use an upper limb prosthesis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "347" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores pronósticos de un resultado funcional satisfactorio en pacientes con amputaciones unilaterales de extremidad superior por arriba de la muñeca que utilizan próstesis de extremidad superior" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 1000 "Tamanyo" => 114549 ] ] "descripcion" => array:1 [ "en" => "Patient with transradial amputation using a forearm stump to place a transfemoral prosthesis." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Dabaghi-Richerand, F. Haces-García, R. Capdevila-Leonori" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Dabaghi-Richerand" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Haces-García" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Capdevila-Leonori" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S188844151400246X" "doi" => "10.1016/j.recot.2014.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S188844151400246X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000541?idApp=UINPBA00004N" "url" => "/19888856/0000005900000005/v1_201508080018/S1988885615000541/v1_201508080018/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1988885615000565" "issn" => "19888856" "doi" => "10.1016/j.recote.2015.07.005" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "552" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:326-32" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 44 "formatos" => array:2 [ "HTML" => 35 "PDF" => 9 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Radiofrequency thermal ablation of osteoid osteomas of the proximal femur. Usefulness of ultrasound guidance in selected cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "326" "paginaFinal" => "332" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Termoablación por radiofrecuencia de osteomas osteoides del extremo proximal del fémur. Utilidad de la ecografía en casos seleccionados" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 977 "Ancho" => 820 "Tamanyo" => 116144 ] ] "descripcion" => array:1 [ "en" => "CT axial cut of the thermal ablation of the nidus in Case 8. The electrode end can be seen in the centre and the erroneous path of the trocar in the first attempt to approach it is displayed." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.R. Ramos-Pascua, V. Martínez-Valderrábano, J.A. Santos-Sánchez, M. Tijerín Bueno, S. Sánchez-Herráez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L.R." "apellidos" => "Ramos-Pascua" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Martínez-Valderrábano" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Santos-Sánchez" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Tijerín Bueno" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Sánchez-Herráez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441514002483" "doi" => "10.1016/j.recot.2014.11.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441514002483?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000565?idApp=UINPBA00004N" "url" => "/19888856/0000005900000005/v1_201508080018/S1988885615000565/v1_201508080018/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Periprosthetic femoral fractures after hemiarthroplasty. An analysis of 17 cases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "342" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Suárez-Huerta, A. Roces-Fernández, R. Mencía-Barrio, J.A. Alonso-Barrio, L.R. Ramos-Pascua" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Suárez-Huerta" "email" => array:1 [ 0 => "msuarez83@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Roces-Fernández" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Mencía-Barrio" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Alonso-Barrio" ] 4 => array:2 [ "nombre" => "L.R." "apellidos" => "Ramos-Pascua" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracturas periprotésicas de fémur sobre hemiartroplastia. Análisis de una serie de 17 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1054 "Ancho" => 1500 "Tamanyo" => 146795 ] ] "descripcion" => array:1 [ "en" => "Case 15. (a) Type B1 fracture; (b) postoperative radiographic monitoring 3 months after the intervention, with delay in consolidation and varus shift in the fracture; (c) radiographic monitoring 3 months after having changed the first plate, which still remains short, with precarious proximal fixation and which has varus shift again." ] ] ] "textoCompleto" => "IntroductionFractures of the femur with some previously implanted material are relatively frequent. Among them, periprosthetic fractures in patients with hip or knee prostheses constitute the majority, and their incidence is increasing day by day because more and more arthroplasties are being implanted due to the ageing and greater demands of the population. The increase of osteoporotic hip fractures for the same motive is another reason. Treatment for all of these fractures is difficult and represents a challenge for multidisciplinary orthogeriatric teams, which have to take care of fracture demands in a context that is often of local and general fragility.The overall incidence of periprosthetic femoral fractures in patients with total hip prostheses is estimated to be around 1–6%, with figures of 1% among the primary and of 2–6% among those of revision (always greater if they are not cemented).<a class="elsevierStyleCrossRefs" href="#bib0145">1–5</a> There are numerous publications about this and the majority of them refer to patients with total prostheses, when they do not group patients with total prostheses and hemiarthroplasties together, or postoperative with intraoperative fractures. Postoperative periprosthetic femoral fractures after hemiarthroplasties have seldom been studied specifically. In fact, in the revisions on the matter carried out by Marsland and Lears,<a class="elsevierStyleCrossRef" href="#bib0165">5</a> Giannoudis et al.<a class="elsevierStyleCrossRef" href="#bib0155">3</a> and Schwarzkopf et al.<a class="elsevierStyleCrossRef" href="#bib0160">4</a> (adding up to a total of 246 references), there is only 1 that expressly mentions periprosthetic fractures after hemiarthroplasties in its title. In addition, the article in question dates back to 1986.<a class="elsevierStyleCrossRef" href="#bib0170">6</a>Hemiarthroplasties or partial hip prostheses are indicated in displaced fractures of the femoral neck or as a rescue for failed osteosynthesis in fractures of this type. The usefulness of the head bipolarity<a class="elsevierStyleCrossRef" href="#bib0175">7</a> and the age of the patient that is to receive the implant are controversial, given that total prostheses offer better results than partial ones. Cemented prostheses, on the other hand, are preferable to non-cemented ones because they also achieve better functional results.<a class="elsevierStyleCrossRef" href="#bib0180">8</a> In our service (although not as a strict rule and always taking into account general patient condition and any comorbidity), we routinely indicate hemiarthroplasty, always cemented, in patients older than the mean expected survival age in our region, reserving the unipolar Thompson model for the patients of greater age with worse general or functional condition. Life expectancy for the population in Castilla-León is currently calculated to be 81 years for males and 83 years for women.Based on everything that has been indicated previously and considering the demographic characteristics of the population in our setting, which allows us to work with a sample that we estimate as sufficient and relatively homogeneous, we carried out this study, with the following objectives: (1) describe the patient characteristics and the periprosthetic femoral fractures after hemiarthroplasties and (2) critically analyse the treatments given based on their results.Materials and methodsThis was a retrospective, observational, longitudinal study on a series of 17 patients with periprosthetic femoral fractures after hip hemiarthroplasties seen on a continuous basis in our service from 2005 to 2013 (1 in 2005, 1 in 2007, 2 in 2008, 2 in 2009, 6 in 2011, 2 in 2012 and 3 in 2013). Seven hemiarthroplasties were unipolar (6 Thompson type and 1 isoelastic Mathys type), while 10 were various bipolar models. All the unipolar were cemented, including the isoelastic, which was implanted and cemented in another centre. Among the bipolar models, 6 were cemented and 4, cementless. Two fractures were AL type according to the Vancouver classification<a class="elsevierStyleCrossRefs" href="#bib0165">5,9</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>); 10 were type B (6 B1 – <a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a> and 4 B2 – <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>); and 5 were type C (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Three fractures were treated orthopaedically due to fracture type (Case 9) or to the combination of poor general patient condition and poor function (Cases 10 and 12). The remaining patients (14) were treated surgically. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> details the treatment for each case. Cases 4 and 7 were treated with retrograde intramedullary supracondylar nailing (SCN) type (Stryker) nails, which were not overlaid with the prosthesis stem in any case.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Analysis was carried out on the epidemiological and clinical characteristics of the patients in the series, the circumstances in which the fractures occurred and the treatment results with a mean follow-up of 2 years and 23 days until the end of the study or patient death, when applicable (range: 11 days–9 years and 5 months). Results included the local and general complications, readmissions and reinterventions, percentages of consolidation and need for transfusion, mortality data, functional results (G3=walks without support or with a cane; G2=walks with 2 supports or with a walker; G1=requires wheelchair to move around; G0=does not walk or is a bed patient),<a class="elsevierStyleCrossRef" href="#bib0190">10</a> length of hospital stay and destination after discharge. Pseudoarthrosis cases and reinterventions were defined as surgical treatment failures. No patient was lost during follow-up.Surgical treatment, when applicable, was carried out on all patients by physicians in the Hip Unit of the Service according to prevailing surgical protocols. Orthopaedic treatment in the patients that received it consisted of member unloading (Case 9) or immobilisation with inguinal-pedicle plaster (Cases 10 and 12). Patients were discharged when their general condition permitted; patients were sent to a subsidised centre in the same location when they required chronic care not available in another destination. All patients received follow-up in external consultation 1 month after hospital discharge and, after that, at the third and sixth months. Further follow-up visits were annual until patient death.The information for the study was gathered by the first 2 study authors based on patient medical history review, completing the data in all cases by a telephone interview with each patient (or with the patient's relatives or caregivers if the patient had died or was not in condition to respond to the interview). All data treatment was anonymous and confidential, with the data being transferred to a database created with Microsoft Excel 2000 programme, with which the statistical analysis was performed. This consisted of a descriptive analysis of the variables, calculating the distribution of frequencies for the qualitative variables and the median and interquartile range (IQR) for the quantitative. Approval from the hospital's Ethics Committee was unneeded.ResultsEpidemiological and clinical resultsOf the 17 patients in the series, 14 (82%) were women and 3 (18%) were men. Median age was 86 years and the IQR ranged from 72 to 100 years. For the men only, these statistics were a median age of 84 years and the IQR, from 72 to 91; for the women, they were 86 years and IQR, from 78 to 100. Nine fractures involved the right side and 8, the left side. Six patients had some degree of dementia; 6 were on hemostasis-modifying drugs (1 took Adiro 100® and 5, Sintrom®), with a mean intake of 4.7 drugs (range: 0–9). The mean value of the Barthel index was 57 (range: 20–95), and that of the appraisal of self-care agency (ASA) scale, 3.1. The ASA value and functional condition for each patient are indicated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.Fifteen fractures occurred in the patient's normal residence, while 1 was produced during hospital admission (Case 10) and another in the street (Case 11). Fracture cause was an accidental fall in 16 patients. In 1, the fracture was produced by a movement in bed (Case 16). In that patient the fracture occurred 9 months after implanting the hemiarthroplasty, which was complicated by an intraoperative fracture that required fixation with 3 cerclages in the same operation, which could have promoted the new fracture. The periprosthetic fractures arose after a mean time of 6 years and 1 month from the hemiarthroplasty implant (range: 31 days–21 years and 4 months). The fracture occurred in the first 3 months that followed after the original implant in 4 patients (Cases 3, 4, 5 and 6).Results of the treatmentGeneral complications in the series included 2 cases of pressure sores, 1 ankle ulcer, 1 delirium, 1 haematuria, 1 congestive heart failure and 2 progressive multisystem failures that led to the death of both patients at 11 days and 19 days of the intervention (Cases 10 and 7). Case 10 was diagnosed with multiple myeloma.Local complications related to the surgical intervention included 1 infection (from Proteus mirabilis) in a patient that died 35 days after the intervention from multisystem failure (Case 14), 1 postoperative mobilisation of the original prosthesis (Case 5) and 2 cases of pseudoarthrosis (Cases 15 and 16). These last 2 were type B1 fractures treated with Ready type cable-plate systems that seemed short to us in postoperative radiographic monitoring and with a precarious proximal fixation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Both patients were readmitted and operated again with the replacement of the same fixation system and provision of homograft. At present, 4 and 8 months after the revision surgery, they are still alive and have function similar to that before the periprosthetic fracture. The prosthetic mobilisation occurred in a 91-year-old woman that had a type B2 fracture, initially misinterpreted as a B1 and treated with 3 cerclages. Due to immediate sinking of the original prosthesis, she was reoperated and the prosthesis was changed; however, the patient died 68 days after the first surgery during her hospital stay. Excluding 4 patients in whom there was insufficient time for consolidation because of their early death (Cases 5, 7, 10 and 14), 11 fractures were consolidated from the remaining 13 (including Cases 9 and 12 treated orthopaedically) (85%). In all, 3 patients of the 14 operated on were surgical failures (21%). Of the total cases operated, 10 required intra- (2 cases) or postoperative (9 cases) blood transfusions.Nine patients had died at the end of the study, after a mean time period of 387 days since the treatment (range: 11–1550 days). Seven died during the first year, 4 during the first trimester and 2 during the first month. Three patients died during their hospital stay (Cases 5, 7 and 10). Mean age of all the deceased was 89 years; 8 were women, 5 suffered from some degree of dementia, an average of 5.4 drugs were taken, mean Barthel index was 41 and mean ASA score was 3.4 (4 patients with ASA 4).The functional results of the treatment are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Only 5 patients recovered their level of pre-trauma function (Cases 1, 6, 15, 16 and 17).Although 3 patients were transferred to subsidised centres following hospital discharge (Cases 11, 14 and 15), the mean stay in our hospital was 16 days, with an IQR of 1 day (Case 12) to 72 days (Case 5). Excluding the extreme cases 12 and 5, mean hospital stay was 13.5 days. Mean hospital stay for the cases operated was 18 days.DiscussionHemiarthroplasty is the treatment of choice for displaced fractures of the femoral neck in patients of advanced age.<a class="elsevierStyleCrossRefs" href="#bib0175">7,11–13</a> Femoral fractures after hemiarthroplasties are relatively rare and the subject has received much less attention that this type of fracture in femurs with total arthroplasties.<a class="elsevierStyleCrossRefs" href="#bib0205">13–16</a> The exception to this statement is the series of Phillips et al.<a class="elsevierStyleCrossRef" href="#bib0225">17</a> including 79 patients with periprosthetic fractures after hemiarthroplasties recruited consecutively from 1999 to 2010.Periprosthetic femoral fractures in patients with hemiarthroplasties complicate 0–14% of these interventions and are more frequent in cementless implants,<a class="elsevierStyleCrossRefs" href="#bib0195">11–15,17–19</a> which is the reason why these are usually discouraged at the present time. The incidence in cemented stems is estimated to be 0–2% of the cases, while in cementless stems, the estimate is 4–14%. Insofar as age and sex, the age is generally around 85 years and the patient is usually female, as in our experience.<a class="elsevierStyleCrossRefs" href="#bib0205">13,17</a> The condition has been described more frequently in femurs with bipolar implants than in unipolar in a few series, although it has been impossible to specify if this finding was incidental or related with some unknown factor.<a class="elsevierStyleCrossRef" href="#bib0210">14</a> In all cases, including fractures on total prostheses, the most frequent are those of type B (Vancouver classification), representing 30–80% of the total.<a class="elsevierStyleCrossRefs" href="#bib0160">4,17,20</a> In the series of McGraw et al.,<a class="elsevierStyleCrossRef" href="#bib0205">13</a> who analysed 15 patients with fractures on Austin-Moore type cementless prostheses, 13 (87%) were of type B2. In contrast with our series, those researchers did not find any type C fractures.Mean time between total prosthesis implant and fracture is calculated to be 7.4–8.1 years, and 3.9 years when it is a revision prosthesis.<a class="elsevierStyleCrossRefs" href="#bib0160">4,5</a> With a hemiarthroplasty the mean time lapse in the series published has been 24–35 months,<a class="elsevierStyleCrossRefs" href="#bib0205">13,17</a> although those diagnosed during the first month were possibly unnoticed intraoperative fractures.<a class="elsevierStyleCrossRef" href="#bib0225">17</a> In our series, the fact that the fractures occurred at the end of a mean time of more than 6 years might be because the majority were after cemented hemiarthroplasties, which provide the femur more resistance in a hypothetical fall.While the most frequent causes of a postoperative fracture of a femur with a total hip prosthesis are aseptic loosening of the arthroplasty and falls,<a class="elsevierStyleCrossRef" href="#bib0160">4</a> the fractures produced after hemiarthroplasties generally develop without prosthetic loosening. Apart from the technical factors that make the bone more fragile during the primary operation (as in our previously-mentioned Case 16), predisposing factors are considered to be female sex, rheumatoid arthritis, massive osteolysis, advanced age and the osteoporotic disease itself.<a class="elsevierStyleCrossRef" href="#bib0165">5</a> At any rate, the majority are the result of low-energy falls from a seated or standing position.Treating a periprosthetic femoral fracture in a patient with a hemiarthroplasty is difficult and expensive,<a class="elsevierStyleCrossRef" href="#bib0215">15</a> and requires precise therapeutic planning with respect to indication and method. You have to consider the general condition of the patient (often fragile), rule out any underlying infection<a class="elsevierStyleCrossRefs" href="#bib0155">3,5</a> and determine exact fracture type and implant stability, as well as bearing in mind the surgeon's experience.<a class="elsevierStyleCrossRef" href="#bib0220">16</a> To mobilise the patient rapidly and have them recover function, it is necessary to achieve and maintain fracture reduction, ensure implant stability and accelerate osseous healing.As for the type of fracture, type A fractures are usually treated with conservative measures. However, they could compromise implant stability with large fragments or significant periprosthetic osteolysis. Type B1 fractures are normally treated with open reduction and internal fixation using plates or cerclages. Types B2 and B3 are generally treated by replacing the prosthesis with another,<a class="elsevierStyleCrossRef" href="#bib0205">13</a> cemented or not, combined with internal fixation or not. Finally, type C fractures are usually treated with hybrid plates with proximal unicortical screws and cables and distal bicortical; intramedullary devices are reserved for cases in which lesser surgical aggression is desired, attempting to overlay the stem and the nail to avoid stress zones between them.<a class="elsevierStyleCrossRefs" href="#bib0155">3,4,21</a> In reference to this, Zuurmond et al.<a class="elsevierStyleCrossRef" href="#bib0250">22</a> demonstrated that this system, with a specially-designed nail, achieved stable connection with the femoral stem and provided sufficient strength to resist full load. The stem length to be overlaid would be 2–3.5cm. This was not, in either of the 2 cases in our series, even attempted. Another possibility, in selected cases, above all in young patients, would be to combine intramedullary fixation with extramedullary.<a class="elsevierStyleCrossRef" href="#bib0255">23</a> In all Vancouver classification fractures, structural cortical homografts could be used as additional stabilising elements.In our series, 1 of the 2 type AL fractures was operated because it was thought that fracture displacement could compromise implant stability through loss of its medial support. The other AL case was treated orthopaedically, as were 2 other patients for whom surgery was inadvisable after anaesthetic evaluation because of high surgical risk and poor previous functional condition. The remaining patients received surgical interventions appropriate to their type of fracture. Cerclages, plates-cable with uni- and bicortical screws were used as osteosynthesis methods; in 2 patients, retrograde nails that provided discrete but sufficient fixation were also used, taking the estimated survival into consideration. We never used block plates or minimally invasive techniques to implant them, which are described as methods especially useful in osteoporotic bones.<a class="elsevierStyleCrossRefs" href="#bib0160">4,5,16</a> Neither were clamping plates joined to others to allow lateralised fixation of bicortical screws used.<a class="elsevierStyleCrossRef" href="#bib0240">20</a>Patient condition, as well as functionality, consequently affects the therapeutic decision in that a procedure of greater morbidity can be rejected for another that might yield lower morbidity.<a class="elsevierStyleCrossRefs" href="#bib0160">4,16</a> The fact that the age of patients with periprosthetic fractures after hemiarthroplasties is so advanced works in favour of this measure, as does its frequent associated comorbidity.<a class="elsevierStyleCrossRef" href="#bib0225">17</a> In our series, 15 of the 17 patients had elevated anaesthesia risk of ASA 3 or 4.There are many complications after surgical treatment of periprosthetic fractures. A 7–23% of revision surgeries are foreseen in series with a predominance of total arthroplasties.<a class="elsevierStyleCrossRefs" href="#bib0150">2,5,24,25</a> Pseudoarthrosis can be seen in up to 57% of the cases and is difficult to treat.<a class="elsevierStyleCrossRef" href="#bib0270">26</a> Deep infections are also difficult, with the possibility of suppressive treatment in patients of advanced age.<a class="elsevierStyleCrossRef" href="#bib0165">5</a> In hemiarthroplasty series, complications are expected to occur in 42% of the patients, with 3–25% infections, 1–8% haemorrhages and 1–8% assembly failures.<a class="elsevierStyleCrossRef" href="#bib0205">13</a> In the series of Phillips et al.,<a class="elsevierStyleCrossRef" href="#bib0225">17</a> there were 55% medical complications, 4.5% deep infections, 3% pseudoarthrosis cases, 1 luxation and 11% revision operations. The 3 failures in our series represented 21% of the cases operated. Two type B1 fractures were complicated with pseudoarthrosis, attributed to the fact that the plate had been excessively short and had an equally precarious proximal fixation. Although the screw can compromise the cement layer and it is necessary to attempt to reduce their number near the focus of the fracture, at the proximal level at least 4 cortical screws must grip. When the fracture is fixed with a plate, its length should exceed the fracture by, at least, 2 femur widths, which did not happen in our 2 patients. Our third complication was due to classifying a B2 fracture as a B1 and not replacing the original prosthesis in the first surgery, as is recommended.<a class="elsevierStyleCrossRefs" href="#bib0150">2–5,27,28</a> Although the implant was shown to be unstable intraoperatively, the decision was made not to replace it in benefit of a shorter intervention with lower morbility. Later evolution of the case showed that this had not been a good choice, although it probably would not have changed even if the prosthesis had been replaced. At any rate, optimum plate length is unknown, biomechanical studies on the most stable assemblies have not been clinically validated, the general patient condition justifies orthopaedic treatment in some B2 fractures<a class="elsevierStyleCrossRef" href="#bib0170">6</a> and our failure index is compatible with those of other series, which estimate a 24–34% failure rate in treating type B1 fractures.<a class="elsevierStyleCrossRefs" href="#bib0165">5,20</a>Insofar as mortality of patients with periprosthetic fractures, at 6 months this is calculated to be about 7% in total arthroplasties, and between 9% and 11% at 1 year, although it is higher among males and with increasing age.<a class="elsevierStyleCrossRefs" href="#bib0160">4,5</a> However, in the case of hemiarthroplasties, the figures are significantly higher. In the Phillips et al. series,<a class="elsevierStyleCrossRef" href="#bib0225">17</a> 11% died during the first postoperative month, 23% in the first 3 months, 34% by 1 year, 49% at 2 years and 63% at 3 years. In our series, with a mean follow-up of more than 2 years, the figures for the first month, first trimester and at 1 year were 12%, 24% and 41%, respectively. At the end of the study, 53% of the patients had died, with a worse Barthel index score and anaesthesia risk, as was to be expected, than in the global in the series.Postoperative functional recovery among the survivors is unpredictable. In the McGraw et al. series,<a class="elsevierStyleCrossRef" href="#bib0205">13</a> 75% of patients had a significant reduction of mobility. Functional results are equally poor in more than half of the patients with B2 fractures treated with isolated internal fixation.<a class="elsevierStyleCrossRef" href="#bib0155">3</a> In our series, only 29% recovered their functional level from before the trauma.Our study had various limitations, which are repeated in the majority of articles on this subject. The first is that it is a retrospective study. The second is the limited number of cases involved. The third was that there were no control groups for comparison. In spite of this, we consider that the sample was relatively uniform and sufficient. We can also emphasise the study strength represented by the facts that our Service was the only one that treated these fractures in our health care area and that specialists having similar training and commitment managed all the cases.In conclusion, periprosthetic femoral fractures after hemiarthroplasties are likely to increase in frequency in the coming years and have to be taken into consideration. In our setting, such fractures are more frequent in women of an age of approximately 90 years and usually occur in patients with important morbidity. The indication for their treatment should not be based solely on the Vancouver classification, which (although reliable, simple and reproducible) can only be considered a guideline for deciding on the best treatment for a frequently fragile patient. When such treatment is surgical, preoperative planning is fundamental.Level of evidenceLevel of evidence IV.Therapeutic study level IV (case series).Ethical responsibilitiesProtection of persons and animalsThe authors declare that no experiments on human beings or animals were performed in this study.Data confidentialityThe authors declare that their work centre protocols on publication of patient data were followed in this study.Right to privacy and informed consentThe authors obtained the informed consent of the patients or subjects mentioned in this article. This document is held by the corresponding author.FundingThe authors have not received any funding for preparing this study.Conflict of interestsThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres539597" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec559166" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres539596" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Discusión" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec559167" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Epidemiological and clinical results" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Results of the treatment" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Level of evidence" ] 9 => array:3 [ "identificador" => "sec0040" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of persons and animals" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-15" "fechaAceptado" => "2014-11-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec559166" "palabras" => array:5 [ 0 => "Periprosthetic fracture" 1 => "Femur" 2 => "Hemiarthroplasty" 3 => "Vancouver classification" 4 => "Stem" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec559167" "palabras" => array:5 [ 0 => "Fractura periprotésica" 1 => "Fémur" 2 => "Hemiartroplastia" 3 => "Clasificación de Vancouver" 4 => "Vástago" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "PurposeTo describe the characteristics of patients with periprosthetic femoral fractures after hemiarthroplasty and to analyse their treatment. Materials and methodsAn observational, longitudinal, retrospective study was conducted on a series of 17 patients with periprosthetic femoral fractures after hip hemiarthroplasty. Fourteen fractures were treated surgically. The characteristics of patients, fractures and treatment outcomes in terms of complications, mortality and functionality were analysed. ResultsThe large majority (82%) of patients were women; the mean age was 86 years with an ASA index of 3 or 4 in 15 patients. Ten fractures were type B. There were 8 general complications, one deep infection, one mobilisation of a non-exchanged hemiarthroplasty, and 2 non-unions. There were 85% consolidated fractures, and only 5 patients recovered the same function prior to the injury. At the time of the study 9 patients had died (53%). DiscussionPeriprosthetic femoral fractures after hemiarthroplasty will increase in the coming years and their treatment is difficult. ConclusionPeriprosthetic femoral fractures after hemiarthroplasty are more common in women around 90-years-old, and usually occur in patients with significant morbidity. Although the Vancouver classification is reliable, simple and reproducible, it is only a guide to decide on the best treatment in a patient often fragile. The preoperative planning is essential when deciding a surgical treatment." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoDescribir las características de los pacientes y las fracturas femorales periprotésicas sobre hemiartroplastias, y realizar un análisis del tratamiento a partir de sus resultados. Material y métodoEstudio observacional, longitudinal y retrospectivo de una serie de 17 pacientes con fracturas femorales periprotésicas sobre hemiartroplastias de cadera. Catorce se trataron quirúrgicamente. Se analizaron las características de los pacientes y de las fracturas y los resultados del tratamiento en términos de complicaciones, mortalidad y funcionalidad. ResultadosEl 82% de los pacientes fueron mujeres, la edad media fue de 86 años y el índice ASA de 15 de ellos fue 3 o 4. Diez fracturas fueron de tipo B. Se registraron 8 complicaciones generales, una infección profunda, una movilización de la hemiartroplastia no recambiada y 2 seudoartrosis. Consolidaron el 85% de las fracturas y solo 5 pacientes recuperaron la función previa al traumatismo. Al final del estudio habían fallecido 9 pacientes (53%). DiscusiónEl tratamiento de las fracturas periprotésicas sobre hemiartroplastias, cuya frecuencia aumentará en los próximos años, es difícil. ConclusionesLas fracturas femorales periprotésicas sobre hemiartroplastias son más frecuentes en mujeres próximas a los 90 años y suelen ocurrir en pacientes con importante morbilidad. La indicación de su tratamiento no debe basarse solo en la clasificación de Vancouver que, aunque fiable, simple y reproducible, no deja de ser una guía para decidir el mejor tratamiento en un paciente a menudo frágil. Cuando aquel sea quirúrgico, la planificación preoperatoria es fundamental." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Discusión" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Suárez-Huerta M, Roces-Fernández A, Mencía-Barrio R, Alonso-Barrio JA, Ramos-Pascua LR. Fracturas periprotésicas de fémur sobre hemiartroplastia. Análisis de una serie de 17 casos. Rev Esp Cir Ortop Traumatol. 2015;59:333–342." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1402 "Ancho" => 1250 "Tamanyo" => 182754 ] ] "descripcion" => array:1 [ "en" => "Case 6. (a) Type AL fracture, with radiographic monitoring; (b) postoperative radiographic monitoring 4 years after the reduction and fixation with 3 wire cerclages." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1052 "Ancho" => 1500 "Tamanyo" => 143222 ] ] "descripcion" => array:1 [ "en" => "Case 3. (a) Type B1 fracture after cementless hemiarthroplasty in AP projection; (b) in axial projection; (c) radiographic monitoring 3 years after the treatment." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1054 "Ancho" => 1500 "Tamanyo" => 146795 ] ] "descripcion" => array:1 [ "en" => "Case 15. (a) Type B1 fracture; (b) postoperative radiographic monitoring 3 months after the intervention, with delay in consolidation and varus shift in the fracture; (c) radiographic monitoring 3 months after having changed the first plate, which still remains short, with precarious proximal fixation and which has varus shift again." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1453 "Ancho" => 1250 "Tamanyo" => 149564 ] ] "descripcion" => array:1 [ "en" => "Case 17. (a) Type B2 fracture; (b) postoperative radiographic monitoring 3 months afterwards." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1236 "Ancho" => 1500 "Tamanyo" => 181505 ] ] "descripcion" => array:1 [ "en" => "Case 11. (a) Type C fracture after isoelastic hemiarthroplasty; (b) postoperative radiographic monitoring 6 months afterwards, with fracture consolidation; (c) detailed view of the prosthesis, with signs of cotyloid infection. All the images show that the stem had been cemented when it was implanted, more than 20 years before the fracture." ] ] 5 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Age(years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Implant type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Cemented \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Time until fracture (days) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Vancouver classification \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">ASA scale \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Follow-up days (death) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Complications</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Function<a class="elsevierStyleCrossRef" href="#bib0190">10</a></th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revision surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Post \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1770 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">THP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.435 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1860 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerclages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">251<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pressure sore \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plate-cable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.550<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Delirium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrograde nail \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.125<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haematuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerclages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stem sinking. Pressure sore \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerclages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.885 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7235 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrograde nail \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3985 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CPP<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a>+cerclages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.185 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ICC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">810 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orthopaedic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">311<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ankle ulcer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4745 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orthopaedic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unipolar<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7785 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plate-cable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">970 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6050 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orthopaedic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">425 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerclages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">880 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1825 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plate-cable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35<a class="elsevierStyleCrossRef" href="#tblfn0005">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plate-cable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">395 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pseudoarthrosis+varus shift \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BMA+plate+graft \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">270 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plate-cable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">330 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pseudoarthrosis and disassembly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BMA+plate+graft \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bipolar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">850 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CLPP<a class="elsevierStyleCrossRef" href="#tblfn0020">c</a>+cerclages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">240 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">G3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab867131.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "†" "nota" => "death; BMA: bone marrow aplasia; CLPP: cementless partial prosthesis; CPP: cemented partial prosthesis; F: female; M: male; THP: total hip prosthesis." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "The unipolar prosthesis used in Case 11 was the Mathys isoelastic model. The rest of the unipolar prostheses were the Thompson model." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Stem replacement, implanting a new Ceraver model (Ceraver Osteal) cemented partial bipolar prosthesis." ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "c" "nota" => "Stem replacement, implanting a new Solution model (DePuy) cementless partial bipolar prosthesis." ] ] ] "descripcion" => array:1 [ "en" => "Summary of the cases in the series, their treatment and results." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results of treatment of periprosthetic femoral fractures after total hip arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Korbel" 1 => "P. Sponer" 2 => "T. Lucera" 3 => "E. Procházka" 4 => "T. Procek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Med" "fecha" => "2013" "volumen" => "56" "paginaInicial" => "67" "paginaFinal" => "72" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0150" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periprosthetic Vancouver type B1 and C fractures treated by locking-plate osteosynthesis. Fracture union and reoperations in 60 consecutive fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Froberg" 1 => "A. Troelsen" 2 => "M. Brix" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/17453674.2012.747925" "Revista" => array:6 [ "tituloSerie" => "Acta Orthop" "fecha" => "2012" "volumen" => "83" "paginaInicial" => "648" "paginaFinal" => "652" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23140109" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0155" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Principles of internal fixation and selection of implants for periprosthetic femoral fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.V. Giannoudis" 1 => "N.K. Kanakaris" 2 => "E. Tsiridis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2007.02.050" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2007" "volumen" => "38" "paginaInicial" => "669" "paginaFinal" => "687" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17467709" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0160" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Total hip arthroplasty periprosthetic femoral fractures. A review of classification and current treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Schwarzkopf" 1 => "J.K. Oni" 2 => "S.E. Marwin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Bull Hosp J Dis" "fecha" => "2013" "volumen" => "71" "paginaInicial" => "68" "paginaFinal" => "78" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0165" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of periprosthetic femoral fractures associated with total hip arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Marsland" 1 => "S.C. Mears" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2151458512462870" "Revista" => array:6 [ "tituloSerie" => "Geriatr Orthop Surg Rehabil" "fecha" => "2012" "volumen" => "3" "paginaInicial" => "107" "paginaFinal" => "120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23569704" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0170" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemi-arthroplasty of the hip followed by ipsilateral fracture of the femoral shaft" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Barfod" 1 => "J. Steen Jensen" 2 => "D. Hansen" 3 => "E. Larsen" 4 => "H. Menck" 5 => "B. Olsen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "1986" "volumen" => "17" "paginaInicial" => "104" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3770895" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0175" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.N. Cornell" 1 => "D. Levine" 2 => "J. O’Doherty" 3 => "J. Lyden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Orthop" "fecha" => "1998" "volumen" => "348" "paginaInicial" => "67" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9553535" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0180" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periprosthetic bone loss following hemiarthroplasty: a comparison between cemented and cementless hip prosthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Vidovic" 1 => "A. Matejcic" 2 => "M. Punda" 3 => "M. Tomljenovic" 4 => "M. Bekavac-Beslin" 5 => "A. Mijic" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Injury" "fecha" => "2013" "volumen" => "44S3" "paginaInicial" => "S62" "paginaFinal" => "S66" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0185" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.N. Gohar" 1 => "A.B. Shakoor" 2 => "N. Awan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Arthroplast" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "1047" "paginaFinal" => "1050" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0190" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival and functional outcome in patients 90 years of age or older after hip fracture" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Intiso" 1 => "F. di Rienzo" 2 => "G. Grimaldi" 3 => "T. Lombardi" 4 => "P. Fiore" 5 => "G. Maruzzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ageing/afp126" "Revista" => array:6 [ "tituloSerie" => "Age Ageing" "fecha" => "2009" "volumen" => "38" "paginaInicial" => "619" "paginaFinal" => "622" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19633129" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0195" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. An analysis of 33,205 procedures in the Norwegian and Swedish national registries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Rogmark" 1 => "A.M. Fenstad" 2 => "O. Leonardsson" 3 => "L.B. Engesaeter" 4 => "J. Kärrholm" 5 => "O. Furnes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/17453674.2014.885356" "Revista" => array:6 [ "tituloSerie" => "Acta Orthop" "fecha" => "2014" "volumen" => "85" "paginaInicial" => "18" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24460108" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0200" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemiarthroplasty of the hip with and without cement: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Taylor" 1 => "M. Wright" 2 => "M. Zhu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg" "fecha" => "2012" "volumen" => "94A" "paginaInicial" => "577" "paginaFinal" => "583" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0205" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of periprosthetic fractures after hip hemiarthroplasty: are uncemented prostheses unsafe?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.W.W. McGraw" 1 => "S.C. Spende" 2 => "E.J. Baird" 3 => "S.M. Eckhardt" 4 => "G.E. Ayana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2013.07.023" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2013" "volumen" => "44" "paginaInicial" => "1945" "paginaFinal" => "1948" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24001784" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0210" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. 23,509 procedures after femoral neck fractures from the Swedish Hip Arthroplasty Register, 2005–2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O. Leonardsson" 1 => "J. Kärrholm" 2 => "K. Akesson" 3 => "G. Garellick" 4 => "C. Rogmark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/17453674.2012.727076" "Revista" => array:6 [ "tituloSerie" => "Acta Orthop" "fecha" => "2012" "volumen" => "83" "paginaInicial" => "459" "paginaFinal" => "466" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22998529" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0215" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What is the financial cost of treating periprosthetic hip fractures?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.R.A. Philips" 1 => "C. Boulton" 2 => "C.G. Moran" 3 => "A.R.J. Manktelow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2010.06.003" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2011" "volumen" => "42" "paginaInicial" => "146" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20673576" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0220" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment results of a periprosthetic femoral fracture case series: treatment method for Vancouver type B2 fractures can be customized" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Niikura" 1 => "S.Y. Lee" 2 => "Y. Sakai" 3 => "K. Nishida" 4 => "R. Kuroda" 5 => "I. Kurosaka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4055/cios.2014.6.2.138" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Surg" "fecha" => "2014" "volumen" => "6" "paginaInicial" => "138" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24900893" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0225" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.R.A. Phillips" 1 => "C.G. Moran" 2 => "A.R.J. Manktelow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2012.09.015" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2013" "volumen" => "44" "paginaInicial" => "757" "paginaFinal" => "762" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23103113" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0230" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: an observational study of 11,116 hemiarthroplasties from a national register" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.E. Gjertsen" 1 => "S.A. Lie" 2 => "T. Vinje" 3 => "L.B. Engesaeter" 4 => "G. Hallan" 5 => "K. Matre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg" "fecha" => "2012" "volumen" => "94B" "paginaInicial" => "1113" "paginaFinal" => "1119" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0235" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Langslet" 1 => "F. Frihagen" 2 => "V. Opland" 3 => "J.E. Madsen" 4 => "L. Nordsletten" 5 => "W. Figved" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11999-013-3308-9" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2014" "volumen" => "472" "paginaInicial" => "1291" "paginaFinal" => "1299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24081667" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0240" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The locking attachment plate for proximal fixation of periprosthetic femur fractures – a biomechanical comparison of two techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Lenz" 1 => "M. Windolf" 2 => "T. Mückley" 3 => "G.O. Hofmann" 4 => "M. Wagner" 5 => "R.G. Richards" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00264-012-1574-x" "Revista" => array:6 [ "tituloSerie" => "Int Orthop" "fecha" => "2012" "volumen" => "36" "paginaInicial" => "1915" "paginaFinal" => "1921" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22638607" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0245" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biomechanical evaluation of peri- and interprosthetic fractures of the femur" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Lehmann" 1 => "M. Rupprecht" 2 => "N. Hellmers" 3 => "K. Sellenschloh" 4 => "D. Briem" 5 => "K. Püschel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0b013e3181bb8d89" "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "2010" "volumen" => "68" "paginaInicial" => "1459" "paginaFinal" => "1463" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20093986" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0250" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retrograde bridging nailing of periprosthetic femoral fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.G. Zuurmond" 1 => "P. Pilot" 2 => "A.D. Verburg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2006.12.011" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2007" "volumen" => "38" "paginaInicial" => "958" "paginaFinal" => "964" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17306269" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0255" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of an interference fit retrograde nail as an adjunct to plate fixation of a complex Vancouver B1 periprosthetic femoral fracture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.S. Melvin" 1 => "J.L. Smith" 2 => "S.H. Smith" 3 => "J.S. Patt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2012.06.010" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2012" "volumen" => "43" "paginaInicial" => "1779" "paginaFinal" => "1782" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22771122" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0260" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Three hundred and twenty-one periprosthetic femoral fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Lindahl" 1 => "G. Garellick" 2 => "H. Regner" 3 => "P. Herberts" 4 => "H. Malchau" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg" "fecha" => "2006" "volumen" => "88A" "paginaInicial" => "1215" "paginaFinal" => "1222" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0265" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periprosthetic femoral fractures: classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Lindahl" 1 => "H. Malchau" 2 => "P. Herberts" 3 => "G. Garellick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Arthroplast" "fecha" => "2005" "volumen" => "20" "paginaInicial" => "857" "paginaFinal" => "865" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0270" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Locking compression plate fixation of Vancouver type B1 periprosthetic femoral fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Buttaro" 1 => "G. Farfalli" 2 => "P. Parades Núñez" 3 => "F. Comba" 4 => "F. Piccaluga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg" "fecha" => "2007" "volumen" => "89A" "paginaInicial" => "1964" "paginaFinal" => "1969" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0275" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Corten" 1 => "F. Vanrykel" 2 => "J. Bellemans" 3 => "P.R. Frederix" 4 => "J.P. Simon" 5 => "P.L. Broos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg" "fecha" => "2009" "volumen" => "91B" "paginaInicial" => "1424" "paginaFinal" => "1430" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0280" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Principles of treatment for periprosthetic femoral shaft fractures around well fixed total hip arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Pike" 1 => "D. Davidson" 2 => "D. Garbuz" 3 => "C.P. Duncan" 4 => "P.J. O’Brien" 5 => "B.A. Masri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Orthop Surg" "fecha" => "2009" "volumen" => "17" "paginaInicial" => "677" "paginaFinal" => "688" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19880678" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000005900000005/v1_201508080018/S1988885615000553/v1_201508080018/en/main.assets" "Apartado" => array:4 [ "identificador" => "7577" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000005900000005/v1_201508080018/S1988885615000553/v1_201508080018/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000553?idApp=UINPBA00004N"]

Statistics

Original Article

Periprosthetic femoral fractures after hemiarthroplasty. An analysis of 17 cases

Fracturas periprotésicas de fémur sobre hemiartroplastia. Análisis de una serie de 17 casos

M. Suárez-Huerta

Corresponding author

msuarez83@hotmail.com

Corresponding author.

, A. Roces-Fernández, R. Mencía-Barrio, J.A. Alonso-Barrio, L.R. Ramos-Pascua

Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, Spain

Read

3017

Times
was read the article

393

Total PDF

2624

Total HTML

Share statistics

 array:24 [
  "pii" => "S1988885615000553"
  "issn" => "19888856"
  "doi" => "10.1016/j.recote.2015.07.004"
  "estado" => "S300"
  "fechaPublicacion" => "2015-09-01"
  "aid" => "551"
  "copyright" => "SECOT"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:333-42"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 49
    "formatos" => array:2 [
      "HTML" => 45
      "PDF" => 4
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1888441514002471"
      "issn" => "18884415"
      "doi" => "10.1016/j.recot.2014.11.002"
      "estado" => "S300"
      "fechaPublicacion" => "2015-09-01"
      "aid" => "551"
      "copyright" => "SECOT"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:333-42"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 399
        "formatos" => array:3 [
          "EPUB" => 7
          "HTML" => 239
          "PDF" => 153
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Fracturas periprot&#233;sicas de f&#233;mur sobre hemiartroplastia&#46; An&#225;lisis de una serie de 17 casos"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "333"
            "paginaFinal" => "342"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Periprosthetic femoral fractures after hemiarthroplasty&#46; An analysis of 17 cases"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0025"
            "etiqueta" => "Figura 5"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr5.jpeg"
                "Alto" => 1236
                "Ancho" => 1500
                "Tamanyo" => 159754
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Caso 11&#46; a&#41; Fractura tipo C sobre hemiartroplastia isoel&#225;stica&#59; b&#41; control radiogr&#225;fico postoperatorio a los 6 meses&#44; con consolidaci&#243;n de la fractura&#59; c&#41; detalle de la pr&#243;tesis&#44; con signos de cotiloiditis&#46; En todas las im&#225;genes se observa que el v&#225;stago se hab&#237;a cementado cuando se implant&#243;&#44; m&#225;s de 20 a&#241;os antes de la fractura&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Su&#225;rez-Huerta, A&#46; Roces-Fern&#225;ndez, R&#46; Menc&#237;a-Barrio, J&#46;A&#46; Alonso-Barrio, L&#46;R&#46; Ramos-Pascua"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Su&#225;rez-Huerta"
              ]
              1 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Roces-Fern&#225;ndez"
              ]
              2 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Menc&#237;a-Barrio"
              ]
              3 => array:2 [
                "nombre" => "J&#46;A&#46;"
                "apellidos" => "Alonso-Barrio"
              ]
              4 => array:2 [
                "nombre" => "L&#46;R&#46;"
                "apellidos" => "Ramos-Pascua"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1988885615000553"
          "doi" => "10.1016/j.recote.2015.07.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000553?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441514002471?idApp=UINPBA00004N"
      "url" => "/18884415/0000005900000005/v1_201508080021/S1888441514002471/v1_201508080021/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1988885615000541"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2015.07.003"
    "estado" => "S300"
    "fechaPublicacion" => "2015-09-01"
    "aid" => "550"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:343-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 78
      "formatos" => array:2 [
        "HTML" => 57
        "PDF" => 21
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Prognostic factors of a satisfactory functional result in patients with unilateral amputations of the upper limb above the wrist that use an upper limb prosthesis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "343"
          "paginaFinal" => "347"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Factores pron&#243;sticos de un resultado funcional satisfactorio en pacientes con amputaciones unilaterales de extremidad superior por arriba de la mu&#241;eca que utilizan pr&#243;stesis de extremidad superior"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 737
              "Ancho" => 1000
              "Tamanyo" => 114549
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient with transradial amputation using a forearm stump to place a transfemoral prosthesis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Dabaghi-Richerand, F&#46; Haces-Garc&#237;a, R&#46; Capdevila-Leonori"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Dabaghi-Richerand"
            ]
            1 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Haces-Garc&#237;a"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Capdevila-Leonori"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S188844151400246X"
        "doi" => "10.1016/j.recot.2014.11.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S188844151400246X?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000541?idApp=UINPBA00004N"
    "url" => "/19888856/0000005900000005/v1_201508080018/S1988885615000541/v1_201508080018/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1988885615000565"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2015.07.005"
    "estado" => "S300"
    "fechaPublicacion" => "2015-09-01"
    "aid" => "552"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:326-32"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 44
      "formatos" => array:2 [
        "HTML" => 35
        "PDF" => 9
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Radiofrequency thermal ablation of osteoid osteomas of the proximal femur&#46; Usefulness of ultrasound guidance in selected cases"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "326"
          "paginaFinal" => "332"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Termoablaci&#243;n por radiofrecuencia de osteomas osteoides del extremo proximal del f&#233;mur&#46; Utilidad de la ecograf&#237;a en casos seleccionados"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 977
              "Ancho" => 820
              "Tamanyo" => 116144
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CT axial cut of the thermal ablation of the nidus in Case 8&#46; The electrode end can be seen in the centre and the erroneous path of the trocar in the first attempt to approach it is displayed&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L&#46;R&#46; Ramos-Pascua, V&#46; Mart&#237;nez-Valderr&#225;bano, J&#46;A&#46; Santos-S&#225;nchez, M&#46; Tijer&#237;n Bueno, S&#46; S&#225;nchez-Herr&#225;ez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "L&#46;R&#46;"
              "apellidos" => "Ramos-Pascua"
            ]
            1 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Mart&#237;nez-Valderr&#225;bano"
            ]
            2 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Santos-S&#225;nchez"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Tijer&#237;n Bueno"
            ]
            4 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "S&#225;nchez-Herr&#225;ez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441514002483"
        "doi" => "10.1016/j.recot.2014.11.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441514002483?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000565?idApp=UINPBA00004N"
    "url" => "/19888856/0000005900000005/v1_201508080018/S1988885615000565/v1_201508080018/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Periprosthetic femoral fractures after hemiarthroplasty&#46; An analysis of 17 cases"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "333"
        "paginaFinal" => "342"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Su&#225;rez-Huerta, A&#46; Roces-Fern&#225;ndez, R&#46; Menc&#237;a-Barrio, J&#46;A&#46; Alonso-Barrio, L&#46;R&#46; Ramos-Pascua"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Su&#225;rez-Huerta"
            "email" => array:1 [
              0 => "msuarez83&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Roces-Fern&#225;ndez"
          ]
          2 => array:2 [
            "nombre" => "R&#46;"
            "apellidos" => "Menc&#237;a-Barrio"
          ]
          3 => array:2 [
            "nombre" => "J&#46;A&#46;"
            "apellidos" => "Alonso-Barrio"
          ]
          4 => array:2 [
            "nombre" => "L&#46;R&#46;"
            "apellidos" => "Ramos-Pascua"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#44; Complejo Asistencial Universitario de Le&#243;n&#44; Gerencia Regional de Salud de Castilla y Le&#243;n &#40;SACYL&#41;&#44; Le&#243;n&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Fracturas periprot&#233;sicas de f&#233;mur sobre hemiartroplastia&#46; An&#225;lisis de una serie de 17 casos"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1054
            "Ancho" => 1500
            "Tamanyo" => 146795
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Case 15&#46; &#40;a&#41; Type B1 fracture&#59; &#40;b&#41; postoperative radiographic monitoring 3 months after the intervention&#44; with delay in consolidation and varus shift in the fracture&#59; &#40;c&#41; radiographic monitoring 3 months after having changed the first plate&#44; which still remains short&#44; with precarious proximal fixation and which has varus shift again&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fractures of the femur with some previously implanted material are relatively frequent&#46; Among them&#44; periprosthetic fractures in patients with hip or knee prostheses constitute the majority&#44; and their incidence is increasing day by day because more and more arthroplasties are being implanted due to the ageing and greater demands of the population&#46; The increase of osteoporotic hip fractures for the same motive is another reason&#46; Treatment for all of these fractures is difficult and represents a challenge for multidisciplinary orthogeriatric teams&#44; which have to take care of fracture demands in a context that is often of local and general fragility&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The overall incidence of periprosthetic femoral fractures in patients with total hip prostheses is estimated to be around 1&#8211;6&#37;&#44; with figures of 1&#37; among the primary and of 2&#8211;6&#37; among those of revision &#40;always greater if they are not cemented&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#8211;5</span></a> There are numerous publications about this and the majority of them refer to patients with total prostheses&#44; when they do not group patients with total prostheses and hemiarthroplasties together&#44; or postoperative with intraoperative fractures&#46; Postoperative periprosthetic femoral fractures after hemiarthroplasties have seldom been studied specifically&#46; In fact&#44; in the revisions on the matter carried out by Marsland and Lears&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> Giannoudis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> and Schwarzkopf et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a> &#40;adding up to a total of 246 references&#41;&#44; there is only 1 that expressly mentions periprosthetic fractures after hemiarthroplasties in its title&#46; In addition&#44; the article in question dates back to 1986&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Hemiarthroplasties or partial hip prostheses are indicated in displaced fractures of the femoral neck or as a rescue for failed osteosynthesis in fractures of this type&#46; The usefulness of the head bipolarity<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> and the age of the patient that is to receive the implant are controversial&#44; given that total prostheses offer better results than partial ones&#46; Cemented prostheses&#44; on the other hand&#44; are preferable to non-cemented ones because they also achieve better functional results&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> In our service &#40;although not as a strict rule and always taking into account general patient condition and any comorbidity&#41;&#44; we routinely indicate hemiarthroplasty&#44; always cemented&#44; in patients older than the mean expected survival age in our region&#44; reserving the unipolar Thompson model for the patients of greater age with worse general or functional condition&#46; Life expectancy for the population in Castilla-Le&#243;n is currently calculated to be 81 years for males and 83 years for women&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on everything that has been indicated previously and considering the demographic characteristics of the population in our setting&#44; which allows us to work with a sample that we estimate as sufficient and relatively homogeneous&#44; we carried out this study&#44; with the following objectives&#58; &#40;1&#41; describe the patient characteristics and the periprosthetic femoral fractures after hemiarthroplasties and &#40;2&#41; critically analyse the treatments given based on their results&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective&#44; observational&#44; longitudinal study on a series of 17 patients with periprosthetic femoral fractures after hip hemiarthroplasties seen on a continuous basis in our service from 2005 to 2013 &#40;1 in 2005&#44; 1 in 2007&#44; 2 in 2008&#44; 2 in 2009&#44; 6 in 2011&#44; 2 in 2012 and 3 in 2013&#41;&#46; Seven hemiarthroplasties were unipolar &#40;6 Thompson type and 1 isoelastic Mathys type&#41;&#44; while 10 were various bipolar models&#46; All the unipolar were cemented&#44; including the isoelastic&#44; which was implanted and cemented in another centre&#46; Among the bipolar models&#44; 6 were cemented and 4&#44; cementless&#46; Two fractures were AL type according to the Vancouver classification<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#59; 10 were type B &#40;6 B1 &#8211; <a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a> and 4 B2 &#8211; <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#59; and 5 were type C &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Three fractures were treated orthopaedically due to fracture type &#40;Case 9&#41; or to the combination of poor general patient condition and poor function &#40;Cases 10 and 12&#41;&#46; The remaining patients &#40;14&#41; were treated surgically&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> details the treatment for each case&#46; Cases 4 and 7 were treated with retrograde intramedullary supracondylar nailing &#40;SCN&#41; type &#40;Stryker&#41; nails&#44; which were not overlaid with the prosthesis stem in any case&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Analysis was carried out on the epidemiological and clinical characteristics of the patients in the series&#44; the circumstances in which the fractures occurred and the treatment results with a mean follow-up of 2 years and 23 days until the end of the study or patient death&#44; when applicable &#40;range&#58; 11 days&#8211;9 years and 5 months&#41;&#46; Results included the local and general complications&#44; readmissions and reinterventions&#44; percentages of consolidation and need for transfusion&#44; mortality data&#44; functional results &#40;G3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>walks without support or with a cane&#59; G2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>walks with 2 supports or with a walker&#59; G1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>requires wheelchair to move around&#59; G0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>does not walk or is a bed patient&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a> length of hospital stay and destination after discharge&#46; Pseudoarthrosis cases and reinterventions were defined as surgical treatment failures&#46; No patient was lost during follow-up&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgical treatment&#44; when applicable&#44; was carried out on all patients by physicians in the Hip Unit of the Service according to prevailing surgical protocols&#46; Orthopaedic treatment in the patients that received it consisted of member unloading &#40;Case 9&#41; or immobilisation with inguinal-pedicle plaster &#40;Cases 10 and 12&#41;&#46; Patients were discharged when their general condition permitted&#59; patients were sent to a subsidised centre in the same location when they required chronic care not available in another destination&#46; All patients received follow-up in external consultation 1 month after hospital discharge and&#44; after that&#44; at the third and sixth months&#46; Further follow-up visits were annual until patient death&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The information for the study was gathered by the first 2 study authors based on patient medical history review&#44; completing the data in all cases by a telephone interview with each patient &#40;or with the patient&#39;s relatives or caregivers if the patient had died or was not in condition to respond to the interview&#41;&#46; All data treatment was anonymous and confidential&#44; with the data being transferred to a database created with Microsoft Excel 2000 programme&#44; with which the statistical analysis was performed&#46; This consisted of a descriptive analysis of the variables&#44; calculating the distribution of frequencies for the qualitative variables and the median and interquartile range &#40;IQR&#41; for the quantitative&#46; Approval from the hospital&#39;s Ethics Committee was unneeded&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Epidemiological and clinical results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Of the 17 patients in the series&#44; 14 &#40;82&#37;&#41; were women and 3 &#40;18&#37;&#41; were men&#46; Median age was 86 years and the IQR ranged from 72 to 100 years&#46; For the men only&#44; these statistics were a median age of 84 years and the IQR&#44; from 72 to 91&#59; for the women&#44; they were 86 years and IQR&#44; from 78 to 100&#46; Nine fractures involved the right side and 8&#44; the left side&#46; Six patients had some degree of dementia&#59; 6 were on hemostasis-modifying drugs &#40;1 took Adiro 100<span class="elsevierStyleSup">&#174;</span> and 5&#44; Sintrom<span class="elsevierStyleSup">&#174;</span>&#41;&#44; with a mean intake of 4&#46;7 drugs &#40;range&#58; 0&#8211;9&#41;&#46; The mean value of the Barthel index was 57 &#40;range&#58; 20&#8211;95&#41;&#44; and that of the appraisal of self-care agency &#40;ASA&#41; scale&#44; 3&#46;1&#46; The ASA value and functional condition for each patient are indicated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Fifteen fractures occurred in the patient&#39;s normal residence&#44; while 1 was produced during hospital admission &#40;Case 10&#41; and another in the street &#40;Case 11&#41;&#46; Fracture cause was an accidental fall in 16 patients&#46; In 1&#44; the fracture was produced by a movement in bed &#40;Case 16&#41;&#46; In that patient the fracture occurred 9 months after implanting the hemiarthroplasty&#44; which was complicated by an intraoperative fracture that required fixation with 3 cerclages in the same operation&#44; which could have promoted the new fracture&#46; The periprosthetic fractures arose after a mean time of 6 years and 1 month from the hemiarthroplasty implant &#40;range&#58; 31 days&#8211;21 years and 4 months&#41;&#46; The fracture occurred in the first 3 months that followed after the original implant in 4 patients &#40;Cases 3&#44; 4&#44; 5 and 6&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results of the treatment</span><p id="par0055" class="elsevierStylePara elsevierViewall">General complications in the series included 2 cases of pressure sores&#44; 1 ankle ulcer&#44; 1 delirium&#44; 1 haematuria&#44; 1 congestive heart failure and 2 progressive multisystem failures that led to the death of both patients at 11 days and 19 days of the intervention &#40;Cases 10 and 7&#41;&#46; Case 10 was diagnosed with multiple myeloma&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Local complications related to the surgical intervention included 1 infection &#40;from <span class="elsevierStyleItalic">Proteus mirabilis</span>&#41; in a patient that died 35 days after the intervention from multisystem failure &#40;Case 14&#41;&#44; 1 postoperative mobilisation of the original prosthesis &#40;Case 5&#41; and 2 cases of pseudoarthrosis &#40;Cases 15 and 16&#41;&#46; These last 2 were type B1 fractures treated with Ready type cable-plate systems that seemed short to us in postoperative radiographic monitoring and with a precarious proximal fixation &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Both patients were readmitted and operated again with the replacement of the same fixation system and provision of homograft&#46; At present&#44; 4 and 8 months after the revision surgery&#44; they are still alive and have function similar to that before the periprosthetic fracture&#46; The prosthetic mobilisation occurred in a 91-year-old woman that had a type B2 fracture&#44; initially misinterpreted as a B1 and treated with 3 cerclages&#46; Due to immediate sinking of the original prosthesis&#44; she was reoperated and the prosthesis was changed&#59; however&#44; the patient died 68 days after the first surgery during her hospital stay&#46; Excluding 4 patients in whom there was insufficient time for consolidation because of their early death &#40;Cases 5&#44; 7&#44; 10 and 14&#41;&#44; 11 fractures were consolidated from the remaining 13 &#40;including Cases 9 and 12 treated orthopaedically&#41; &#40;85&#37;&#41;&#46; In all&#44; 3 patients of the 14 operated on were surgical failures &#40;21&#37;&#41;&#46; Of the total cases operated&#44; 10 required intra- &#40;2 cases&#41; or postoperative &#40;9 cases&#41; blood transfusions&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Nine patients had died at the end of the study&#44; after a mean time period of 387 days since the treatment &#40;range&#58; 11&#8211;1550 days&#41;&#46; Seven died during the first year&#44; 4 during the first trimester and 2 during the first month&#46; Three patients died during their hospital stay &#40;Cases 5&#44; 7 and 10&#41;&#46; Mean age of all the deceased was 89 years&#59; 8 were women&#44; 5 suffered from some degree of dementia&#44; an average of 5&#46;4 drugs were taken&#44; mean Barthel index was 41 and mean ASA score was 3&#46;4 &#40;4 patients with ASA 4&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The functional results of the treatment are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Only 5 patients recovered their level of pre-trauma function &#40;Cases 1&#44; 6&#44; 15&#44; 16 and 17&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Although 3 patients were transferred to subsidised centres following hospital discharge &#40;Cases 11&#44; 14 and 15&#41;&#44; the mean stay in our hospital was 16 days&#44; with an IQR of 1 day &#40;Case 12&#41; to 72 days &#40;Case 5&#41;&#46; Excluding the extreme cases 12 and 5&#44; mean hospital stay was 13&#46;5 days&#46; Mean hospital stay for the cases operated was 18 days&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Hemiarthroplasty is the treatment of choice for displaced fractures of the femoral neck in patients of advanced age&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">7&#44;11&#8211;13</span></a> Femoral fractures after hemiarthroplasties are relatively rare and the subject has received much less attention that this type of fracture in femurs with total arthroplasties&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13&#8211;16</span></a> The exception to this statement is the series of Phillips et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> including 79 patients with periprosthetic fractures after hemiarthroplasties recruited consecutively from 1999 to 2010&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Periprosthetic femoral fractures in patients with hemiarthroplasties complicate 0&#8211;14&#37; of these interventions and are more frequent in cementless implants&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">11&#8211;15&#44;17&#8211;19</span></a> which is the reason why these are usually discouraged at the present time&#46; The incidence in cemented stems is estimated to be 0&#8211;2&#37; of the cases&#44; while in cementless stems&#44; the estimate is 4&#8211;14&#37;&#46; Insofar as age and sex&#44; the age is generally around 85 years and the patient is usually female&#44; as in our experience&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13&#44;17</span></a> The condition has been described more frequently in femurs with bipolar implants than in unipolar in a few series&#44; although it has been impossible to specify if this finding was incidental or related with some unknown factor&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a> In all cases&#44; including fractures on total prostheses&#44; the most frequent are those of type B &#40;Vancouver classification&#41;&#44; representing 30&#8211;80&#37; of the total&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;17&#44;20</span></a> In the series of McGraw et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> who analysed 15 patients with fractures on Austin-Moore type cementless prostheses&#44; 13 &#40;87&#37;&#41; were of type B2&#46; In contrast with our series&#44; those researchers did not find any type C fractures&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Mean time between total prosthesis implant and fracture is calculated to be 7&#46;4&#8211;8&#46;1 years&#44; and 3&#46;9 years when it is a revision prosthesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;5</span></a> With a hemiarthroplasty the mean time lapse in the series published has been 24&#8211;35 months&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13&#44;17</span></a> although those diagnosed during the first month were possibly unnoticed intraoperative fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> In our series&#44; the fact that the fractures occurred at the end of a mean time of more than 6 years might be because the majority were after cemented hemiarthroplasties&#44; which provide the femur more resistance in a hypothetical fall&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">While the most frequent causes of a postoperative fracture of a femur with a total hip prosthesis are aseptic loosening of the arthroplasty and falls&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a> the fractures produced after hemiarthroplasties generally develop without prosthetic loosening&#46; Apart from the technical factors that make the bone more fragile during the primary operation &#40;as in our previously-mentioned Case 16&#41;&#44; predisposing factors are considered to be female sex&#44; rheumatoid arthritis&#44; massive osteolysis&#44; advanced age and the osteoporotic disease itself&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> At any rate&#44; the majority are the result of low-energy falls from a seated or standing position&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Treating a periprosthetic femoral fracture in a patient with a hemiarthroplasty is difficult and expensive&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a> and requires precise therapeutic planning with respect to indication and method&#46; You have to consider the general condition of the patient &#40;often fragile&#41;&#44; rule out any underlying infection<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;5</span></a> and determine exact fracture type and implant stability&#44; as well as bearing in mind the surgeon&#39;s experience&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> To mobilise the patient rapidly and have them recover function&#44; it is necessary to achieve and maintain fracture reduction&#44; ensure implant stability and accelerate osseous healing&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As for the type of fracture&#44; type A fractures are usually treated with conservative measures&#46; However&#44; they could compromise implant stability with large fragments or significant periprosthetic osteolysis&#46; Type B1 fractures are normally treated with open reduction and internal fixation using plates or cerclages&#46; Types B2 and B3 are generally treated by replacing the prosthesis with another&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> cemented or not&#44; combined with internal fixation or not&#46; Finally&#44; type C fractures are usually treated with hybrid plates with proximal unicortical screws and cables and distal bicortical&#59; intramedullary devices are reserved for cases in which lesser surgical aggression is desired&#44; attempting to overlay the stem and the nail to avoid stress zones between them&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;21</span></a> In reference to this&#44; Zuurmond et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> demonstrated that this system&#44; with a specially-designed nail&#44; achieved stable connection with the femoral stem and provided sufficient strength to resist full load&#46; The stem length to be overlaid would be 2&#8211;3&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46; This was not&#44; in either of the 2 cases in our series&#44; even attempted&#46; Another possibility&#44; in selected cases&#44; above all in young patients&#44; would be to combine intramedullary fixation with extramedullary&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> In all Vancouver classification fractures&#44; structural cortical homografts could be used as additional stabilising elements&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In our series&#44; 1 of the 2 type AL fractures was operated because it was thought that fracture displacement could compromise implant stability through loss of its medial support&#46; The other AL case was treated orthopaedically&#44; as were 2 other patients for whom surgery was inadvisable after anaesthetic evaluation because of high surgical risk and poor previous functional condition&#46; The remaining patients received surgical interventions appropriate to their type of fracture&#46; Cerclages&#44; plates-cable with uni- and bicortical screws were used as osteosynthesis methods&#59; in 2 patients&#44; retrograde nails that provided discrete but sufficient fixation were also used&#44; taking the estimated survival into consideration&#46; We never used block plates or minimally invasive techniques to implant them&#44; which are described as methods especially useful in osteoporotic bones&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;5&#44;16</span></a> Neither were clamping plates joined to others to allow lateralised fixation of bicortical screws used&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Patient condition&#44; as well as functionality&#44; consequently affects the therapeutic decision in that a procedure of greater morbidity can be rejected for another that might yield lower morbidity&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;16</span></a> The fact that the age of patients with periprosthetic fractures after hemiarthroplasties is so advanced works in favour of this measure&#44; as does its frequent associated comorbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> In our series&#44; 15 of the 17 patients had elevated anaesthesia risk of ASA 3 or 4&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">There are many complications after surgical treatment of periprosthetic fractures&#46; A 7&#8211;23&#37; of revision surgeries are foreseen in series with a predominance of total arthroplasties&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;5&#44;24&#44;25</span></a> Pseudoarthrosis can be seen in up to 57&#37; of the cases and is difficult to treat&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> Deep infections are also difficult&#44; with the possibility of suppressive treatment in patients of advanced age&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> In hemiarthroplasty series&#44; complications are expected to occur in 42&#37; of the patients&#44; with 3&#8211;25&#37; infections&#44; 1&#8211;8&#37; haemorrhages and 1&#8211;8&#37; assembly failures&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> In the series of Phillips et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> there were 55&#37; medical complications&#44; 4&#46;5&#37; deep infections&#44; 3&#37; pseudoarthrosis cases&#44; 1 luxation and 11&#37; revision operations&#46; The 3 failures in our series represented 21&#37; of the cases operated&#46; Two type B1 fractures were complicated with pseudoarthrosis&#44; attributed to the fact that the plate had been excessively short and had an equally precarious proximal fixation&#46; Although the screw can compromise the cement layer and it is necessary to attempt to reduce their number near the focus of the fracture&#44; at the proximal level at least 4 cortical screws must grip&#46; When the fracture is fixed with a plate&#44; its length should exceed the fracture by&#44; at least&#44; 2 femur widths&#44; which did not happen in our 2 patients&#46; Our third complication was due to classifying a B2 fracture as a B1 and not replacing the original prosthesis in the first surgery&#44; as is recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#8211;5&#44;27&#44;28</span></a> Although the implant was shown to be unstable intraoperatively&#44; the decision was made not to replace it in benefit of a shorter intervention with lower morbility&#46; Later evolution of the case showed that this had not been a good choice&#44; although it probably would not have changed even if the prosthesis had been replaced&#46; At any rate&#44; optimum plate length is unknown&#44; biomechanical studies on the most stable assemblies have not been clinically validated&#44; the general patient condition justifies orthopaedic treatment in some B2 fractures<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> and our failure index is compatible with those of other series&#44; which estimate a 24&#8211;34&#37; failure rate in treating type B1 fractures&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;20</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Insofar as mortality of patients with periprosthetic fractures&#44; at 6 months this is calculated to be about 7&#37; in total arthroplasties&#44; and between 9&#37; and 11&#37; at 1 year&#44; although it is higher among males and with increasing age&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;5</span></a> However&#44; in the case of hemiarthroplasties&#44; the figures are significantly higher&#46; In the Phillips et al&#46; series&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> 11&#37; died during the first postoperative month&#44; 23&#37; in the first 3 months&#44; 34&#37; by 1 year&#44; 49&#37; at 2 years and 63&#37; at 3 years&#46; In our series&#44; with a mean follow-up of more than 2 years&#44; the figures for the first month&#44; first trimester and at 1 year were 12&#37;&#44; 24&#37; and 41&#37;&#44; respectively&#46; At the end of the study&#44; 53&#37; of the patients had died&#44; with a worse Barthel index score and anaesthesia risk&#44; as was to be expected&#44; than in the global in the series&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Postoperative functional recovery among the survivors is unpredictable&#46; In the McGraw et al&#46; series&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> 75&#37; of patients had a significant reduction of mobility&#46; Functional results are equally poor in more than half of the patients with B2 fractures treated with isolated internal fixation&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> In our series&#44; only 29&#37; recovered their functional level from before the trauma&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our study had various limitations&#44; which are repeated in the majority of articles on this subject&#46; The first is that it is a retrospective study&#46; The second is the limited number of cases involved&#46; The third was that there were no control groups for comparison&#46; In spite of this&#44; we consider that the sample was relatively uniform and sufficient&#46; We can also emphasise the study strength represented by the facts that our Service was the only one that treated these fractures in our health care area and that specialists having similar training and commitment managed all the cases&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; periprosthetic femoral fractures after hemiarthroplasties are likely to increase in frequency in the coming years and have to be taken into consideration&#46; In our setting&#44; such fractures are more frequent in women of an age of approximately 90 years and usually occur in patients with important morbidity&#46; The indication for their treatment should not be based solely on the Vancouver classification&#44; which &#40;although reliable&#44; simple and reproducible&#41; can only be considered a guideline for deciding on the best treatment for a frequently fragile patient&#46; When such treatment is surgical&#44; preoperative planning is fundamental&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Level of evidence</span><p id="par0145" class="elsevierStylePara elsevierViewall">Level of evidence <span class="elsevierStyleSmallCaps">IV&#46;</span></p><p id="par0150" class="elsevierStylePara elsevierViewall">Therapeutic study level <span class="elsevierStyleSmallCaps">IV</span> &#40;case series&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethical responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protection of persons and animals</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no experiments on human beings or animals were performed in this study&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Data confidentiality</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that their work centre protocols on publication of patient data were followed in this study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Right to privacy and informed consent</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors obtained the informed consent of the patients or subjects mentioned in this article&#46; This document is held by the corresponding author&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have not received any funding for preparing this study&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres539597"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Purpose"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Materials and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Discussion"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec559166"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres539596"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Material y m&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Discusi&#243;n"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec559167"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Epidemiological and clinical results"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Results of the treatment"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Level of evidence"
        ]
        9 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Protection of persons and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflict of interests"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-09-15"
    "fechaAceptado" => "2014-11-03"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec559166"
          "palabras" => array:5 [
            0 => "Periprosthetic fracture"
            1 => "Femur"
            2 => "Hemiarthroplasty"
            3 => "Vancouver classification"
            4 => "Stem"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec559167"
          "palabras" => array:5 [
            0 => "Fractura periprot&#233;sica"
            1 => "F&#233;mur"
            2 => "Hemiartroplastia"
            3 => "Clasificaci&#243;n de Vancouver"
            4 => "V&#225;stago"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the characteristics of patients with periprosthetic femoral fractures after hemiarthroplasty and to analyse their treatment&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; longitudinal&#44; retrospective study was conducted on a series of 17 patients with periprosthetic femoral fractures after hip hemiarthroplasty&#46; Fourteen fractures were treated surgically&#46; The characteristics of patients&#44; fractures and treatment outcomes in terms of complications&#44; mortality and functionality were analysed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The large majority &#40;82&#37;&#41; of patients were women&#59; the mean age was 86 years with an ASA index of 3 or 4 in 15 patients&#46; Ten fractures were type B&#46; There were 8 general complications&#44; one deep infection&#44; one mobilisation of a non-exchanged hemiarthroplasty&#44; and 2 non-unions&#46; There were 85&#37; consolidated fractures&#44; and only 5 patients recovered the same function prior to the injury&#46; At the time of the study 9 patients had died &#40;53&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Periprosthetic femoral fractures after hemiarthroplasty will increase in the coming years and their treatment is difficult&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Periprosthetic femoral fractures after hemiarthroplasty are more common in women around 90-years-old&#44; and usually occur in patients with significant morbidity&#46; Although the Vancouver classification is reliable&#44; simple and reproducible&#44; it is only a guide to decide on the best treatment in a patient often fragile&#46; The preoperative planning is essential when deciding a surgical treatment&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Purpose"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Discussion"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas de los pacientes y las fracturas femorales periprot&#233;sicas sobre hemiartroplastias&#44; y realizar un an&#225;lisis del tratamiento a partir de sus resultados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; longitudinal y retrospectivo de una serie de 17 pacientes con fracturas femorales periprot&#233;sicas sobre hemiartroplastias de cadera&#46; Catorce se trataron quir&#250;rgicamente&#46; Se analizaron las caracter&#237;sticas de los pacientes y de las fracturas y los resultados del tratamiento en t&#233;rminos de complicaciones&#44; mortalidad y funcionalidad&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El 82&#37; de los pacientes fueron mujeres&#44; la edad media fue de 86 a&#241;os y el &#237;ndice ASA de 15 de ellos fue 3 o 4&#46; Diez fracturas fueron de tipo B&#46; Se registraron 8 complicaciones generales&#44; una infecci&#243;n profunda&#44; una movilizaci&#243;n de la hemiartroplastia no recambiada y 2 seudoartrosis&#46; Consolidaron el 85&#37; de las fracturas y solo 5 pacientes recuperaron la funci&#243;n previa al traumatismo&#46; Al final del estudio hab&#237;an fallecido 9 pacientes &#40;53&#37;&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El tratamiento de las fracturas periprot&#233;sicas sobre hemiartroplastias&#44; cuya frecuencia aumentar&#225; en los pr&#243;ximos a&#241;os&#44; es dif&#237;cil&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Las fracturas femorales periprot&#233;sicas sobre hemiartroplastias son m&#225;s frecuentes en mujeres pr&#243;ximas a los 90 a&#241;os y suelen ocurrir en pacientes con importante morbilidad&#46; La indicaci&#243;n de su tratamiento no debe basarse solo en la clasificaci&#243;n de Vancouver que&#44; aunque fiable&#44; simple y reproducible&#44; no deja de ser una gu&#237;a para decidir el mejor tratamiento en un paciente a menudo fr&#225;gil&#46; Cuando aquel sea quir&#250;rgico&#44; la planificaci&#243;n preoperatoria es fundamental&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Material y m&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Discusi&#243;n"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Su&#225;rez-Huerta M&#44; Roces-Fern&#225;ndez A&#44; Menc&#237;a-Barrio R&#44; Alonso-Barrio JA&#44; Ramos-Pascua LR&#46; Fracturas periprot&#233;sicas de f&#233;mur sobre hemiartroplastia&#46; An&#225;lisis de una serie de 17 casos&#46; Rev Esp Cir Ortop Traumatol&#46; 2015&#59;59&#58;333&#8211;342&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1402
            "Ancho" => 1250
            "Tamanyo" => 182754
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Case 6&#46; &#40;a&#41; Type AL fracture&#44; with radiographic monitoring&#59; &#40;b&#41; postoperative radiographic monitoring 4 years after the reduction and fixation with 3 wire cerclages&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1052
            "Ancho" => 1500
            "Tamanyo" => 143222
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Case 3&#46; &#40;a&#41; Type B1 fracture after cementless hemiarthroplasty in AP projection&#59; &#40;b&#41; in axial projection&#59; &#40;c&#41; radiographic monitoring 3 years after the treatment&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1054
            "Ancho" => 1500
            "Tamanyo" => 146795
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Case 15&#46; &#40;a&#41; Type B1 fracture&#59; &#40;b&#41; postoperative radiographic monitoring 3 months after the intervention&#44; with delay in consolidation and varus shift in the fracture&#59; &#40;c&#41; radiographic monitoring 3 months after having changed the first plate&#44; which still remains short&#44; with precarious proximal fixation and which has varus shift again&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1453
            "Ancho" => 1250
            "Tamanyo" => 149564
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Case 17&#46; &#40;a&#41; Type B2 fracture&#59; &#40;b&#41; postoperative radiographic monitoring 3 months afterwards&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1236
            "Ancho" => 1500
            "Tamanyo" => 181505
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Case 11&#46; &#40;a&#41; Type C fracture after isoelastic hemiarthroplasty&#59; &#40;b&#41; postoperative radiographic monitoring 6 months afterwards&#44; with fracture consolidation&#59; &#40;c&#41; detailed view of the prosthesis&#44; with signs of cotyloid infection&#46; All the images show that the stem had been cemented when it was implanted&#44; more than 20 years before the fracture&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Age&#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Implant type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Cemented&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Time until fracture &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Vancouver classification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">ASA scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Follow-up days &#40;death&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Complications</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Function<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a></th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revision surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1770&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">THP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;435&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1860&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerclages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">251<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pressure sore&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plate-cable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;550<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Delirium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrograde nail&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;125<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Haematuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerclages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stem sinking&#46; Pressure sore&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerclages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;885&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrograde nail&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3985&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CPP<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cerclages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ICC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">810&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orthopaedic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">311<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ankle ulcer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orthopaedic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unipolar<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7785&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plate-cable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">970&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orthopaedic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">425&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerclages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">880&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1825&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plate-cable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plate-cable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">395&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pseudoarthrosis<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>varus shift&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BMA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>plate<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">270&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plate-cable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">330&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pseudoarthrosis and disassembly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BMA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>plate<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">850&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CLPP<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cerclages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab867131.png"
              ]
            ]
          ]
          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#8224;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">death&#59; BMA&#58; bone marrow aplasia&#59; CLPP&#58; cementless partial prosthesis&#59; CPP&#58; cemented partial prosthesis&#59; F&#58; female&#59; M&#58; male&#59; THP&#58; total hip prosthesis&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The unipolar prosthesis used in Case 11 was the Mathys isoelastic model&#46; The rest of the unipolar prostheses were the Thompson model&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Stem replacement&#44; implanting a new Ceraver model &#40;Ceraver Osteal&#41; cemented partial bipolar prosthesis&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Stem replacement&#44; implanting a new Solution model &#40;DePuy&#41; cementless partial bipolar prosthesis&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Summary of the cases in the series&#44; their treatment and results&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of treatment of periprosthetic femoral fractures after total hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Korbel"
                            1 => "P&#46; Sponer"
                            2 => "T&#46; Lucera"
                            3 => "E&#46; Proch&#225;zka"
                            4 => "T&#46; Procek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Med"
                        "fecha" => "2013"
                        "volumen" => "56"
                        "paginaInicial" => "67"
                        "paginaFinal" => "72"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Periprosthetic Vancouver type B1 and C fractures treated by locking-plate osteosynthesis&#46; Fracture union and reoperations in 60 consecutive fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Froberg"
                            1 => "A&#46; Troelsen"
                            2 => "M&#46; Brix"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/17453674.2012.747925"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Orthop"
                        "fecha" => "2012"
                        "volumen" => "83"
                        "paginaInicial" => "648"
                        "paginaFinal" => "652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23140109"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Principles of internal fixation and selection of implants for periprosthetic femoral fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;V&#46; Giannoudis"
                            1 => "N&#46;K&#46; Kanakaris"
                            2 => "E&#46; Tsiridis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2007.02.050"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2007"
                        "volumen" => "38"
                        "paginaInicial" => "669"
                        "paginaFinal" => "687"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17467709"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total hip arthroplasty periprosthetic femoral fractures&#46; A review of classification and current treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Schwarzkopf"
                            1 => "J&#46;K&#46; Oni"
                            2 => "S&#46;E&#46; Marwin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bull Hosp J Dis"
                        "fecha" => "2013"
                        "volumen" => "71"
                        "paginaInicial" => "68"
                        "paginaFinal" => "78"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review of periprosthetic femoral fractures associated with total hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Marsland"
                            1 => "S&#46;C&#46; Mears"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2151458512462870"
                      "Revista" => array:6 [
                        "tituloSerie" => "Geriatr Orthop Surg Rehabil"
                        "fecha" => "2012"
                        "volumen" => "3"
                        "paginaInicial" => "107"
                        "paginaFinal" => "120"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23569704"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemi-arthroplasty of the hip followed by ipsilateral fracture of the femoral shaft"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Barfod"
                            1 => "J&#46; Steen Jensen"
                            2 => "D&#46; Hansen"
                            3 => "E&#46; Larsen"
                            4 => "H&#46; Menck"
                            5 => "B&#46; Olsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "1986"
                        "volumen" => "17"
                        "paginaInicial" => "104"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3770895"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;N&#46; Cornell"
                            1 => "D&#46; Levine"
                            2 => "J&#46; O&#8217;Doherty"
                            3 => "J&#46; Lyden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop"
                        "fecha" => "1998"
                        "volumen" => "348"
                        "paginaInicial" => "67"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9553535"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Periprosthetic bone loss following hemiarthroplasty&#58; a comparison between cemented and cementless hip prosthesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Vidovic"
                            1 => "A&#46; Matejcic"
                            2 => "M&#46; Punda"
                            3 => "M&#46; Tomljenovic"
                            4 => "M&#46; Bekavac-Beslin"
                            5 => "A&#46; Mijic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2013"
                        "volumen" => "44S3"
                        "paginaInicial" => "S62"
                        "paginaFinal" => "S66"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;N&#46; Gohar"
                            1 => "A&#46;B&#46; Shakoor"
                            2 => "N&#46; Awan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Arthroplast"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1050"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival and functional outcome in patients 90 years of age or older after hip fracture"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Intiso"
                            1 => "F&#46; di Rienzo"
                            2 => "G&#46; Grimaldi"
                            3 => "T&#46; Lombardi"
                            4 => "P&#46; Fiore"
                            5 => "G&#46; Maruzzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ageing/afp126"
                      "Revista" => array:6 [
                        "tituloSerie" => "Age Ageing"
                        "fecha" => "2009"
                        "volumen" => "38"
                        "paginaInicial" => "619"
                        "paginaFinal" => "622"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19633129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients&#46; An analysis of 33&#44;205 procedures in the Norwegian and Swedish national registries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Rogmark"
                            1 => "A&#46;M&#46; Fenstad"
                            2 => "O&#46; Leonardsson"
                            3 => "L&#46;B&#46; Engesaeter"
                            4 => "J&#46; K&#228;rrholm"
                            5 => "O&#46; Furnes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/17453674.2014.885356"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Orthop"
                        "fecha" => "2014"
                        "volumen" => "85"
                        "paginaInicial" => "18"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24460108"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemiarthroplasty of the hip with and without cement&#58; a randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Taylor"
                            1 => "M&#46; Wright"
                            2 => "M&#46; Zhu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg"
                        "fecha" => "2012"
                        "volumen" => "94A"
                        "paginaInicial" => "577"
                        "paginaFinal" => "583"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of periprosthetic fractures after hip hemiarthroplasty&#58; are uncemented prostheses unsafe&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46;W&#46;W&#46; McGraw"
                            1 => "S&#46;C&#46; Spende"
                            2 => "E&#46;J&#46; Baird"
                            3 => "S&#46;M&#46; Eckhardt"
                            4 => "G&#46;E&#46; Ayana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2013.07.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2013"
                        "volumen" => "44"
                        "paginaInicial" => "1945"
                        "paginaFinal" => "1948"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24001784"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Higher risk of reoperation for bipolar and uncemented hemiarthroplasty&#46; 23&#44;509 procedures after femoral neck fractures from the Swedish Hip Arthroplasty Register&#44; 2005&#8211;2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "O&#46; Leonardsson"
                            1 => "J&#46; K&#228;rrholm"
                            2 => "K&#46; Akesson"
                            3 => "G&#46; Garellick"
                            4 => "C&#46; Rogmark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/17453674.2012.727076"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Orthop"
                        "fecha" => "2012"
                        "volumen" => "83"
                        "paginaInicial" => "459"
                        "paginaFinal" => "466"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22998529"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What is the financial cost of treating periprosthetic hip fractures&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;R&#46;A&#46; Philips"
                            1 => "C&#46; Boulton"
                            2 => "C&#46;G&#46; Moran"
                            3 => "A&#46;R&#46;J&#46; Manktelow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2010.06.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2011"
                        "volumen" => "42"
                        "paginaInicial" => "146"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20673576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment results of a periprosthetic femoral fracture case series&#58; treatment method for Vancouver type B2 fractures can be customized"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Niikura"
                            1 => "S&#46;Y&#46; Lee"
                            2 => "Y&#46; Sakai"
                            3 => "K&#46; Nishida"
                            4 => "R&#46; Kuroda"
                            5 => "I&#46; Kurosaka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4055/cios.2014.6.2.138"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Surg"
                        "fecha" => "2014"
                        "volumen" => "6"
                        "paginaInicial" => "138"
                        "paginaFinal" => "145"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24900893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;R&#46;A&#46; Phillips"
                            1 => "C&#46;G&#46; Moran"
                            2 => "A&#46;R&#46;J&#46; Manktelow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2012.09.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2013"
                        "volumen" => "44"
                        "paginaInicial" => "757"
                        "paginaFinal" => "762"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23103113"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck&#58; an observational study of 11&#44;116 hemiarthroplasties from a national register"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;E&#46; Gjertsen"
                            1 => "S&#46;A&#46; Lie"
                            2 => "T&#46; Vinje"
                            3 => "L&#46;B&#46; Engesaeter"
                            4 => "G&#46; Hallan"
                            5 => "K&#46; Matre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg"
                        "fecha" => "2012"
                        "volumen" => "94B"
                        "paginaInicial" => "1113"
                        "paginaFinal" => "1119"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures&#58; 5-year followup of a randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Langslet"
                            1 => "F&#46; Frihagen"
                            2 => "V&#46; Opland"
                            3 => "J&#46;E&#46; Madsen"
                            4 => "L&#46; Nordsletten"
                            5 => "W&#46; Figved"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11999-013-3308-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2014"
                        "volumen" => "472"
                        "paginaInicial" => "1291"
                        "paginaFinal" => "1299"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24081667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The locking attachment plate for proximal fixation of periprosthetic femur fractures &#8211; a biomechanical comparison of two techniques"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lenz"
                            1 => "M&#46; Windolf"
                            2 => "T&#46; M&#252;ckley"
                            3 => "G&#46;O&#46; Hofmann"
                            4 => "M&#46; Wagner"
                            5 => "R&#46;G&#46; Richards"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00264-012-1574-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Orthop"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "1915"
                        "paginaFinal" => "1921"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22638607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biomechanical evaluation of peri- and interprosthetic fractures of the femur"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Lehmann"
                            1 => "M&#46; Rupprecht"
                            2 => "N&#46; Hellmers"
                            3 => "K&#46; Sellenschloh"
                            4 => "D&#46; Briem"
                            5 => "K&#46; P&#252;schel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TA.0b013e3181bb8d89"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2010"
                        "volumen" => "68"
                        "paginaInicial" => "1459"
                        "paginaFinal" => "1463"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20093986"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retrograde bridging nailing of periprosthetic femoral fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;G&#46; Zuurmond"
                            1 => "P&#46; Pilot"
                            2 => "A&#46;D&#46; Verburg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2006.12.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2007"
                        "volumen" => "38"
                        "paginaInicial" => "958"
                        "paginaFinal" => "964"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17306269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of an interference fit retrograde nail as an adjunct to plate fixation of a complex Vancouver B1 periprosthetic femoral fracture"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;S&#46; Melvin"
                            1 => "J&#46;L&#46; Smith"
                            2 => "S&#46;H&#46; Smith"
                            3 => "J&#46;S&#46; Patt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2012.06.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2012"
                        "volumen" => "43"
                        "paginaInicial" => "1779"
                        "paginaFinal" => "1782"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22771122"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Three hundred and twenty-one periprosthetic femoral fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Lindahl"
                            1 => "G&#46; Garellick"
                            2 => "H&#46; Regner"
                            3 => "P&#46; Herberts"
                            4 => "H&#46; Malchau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg"
                        "fecha" => "2006"
                        "volumen" => "88A"
                        "paginaInicial" => "1215"
                        "paginaFinal" => "1222"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Periprosthetic femoral fractures&#58; classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Lindahl"
                            1 => "H&#46; Malchau"
                            2 => "P&#46; Herberts"
                            3 => "G&#46; Garellick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Arthroplast"
                        "fecha" => "2005"
                        "volumen" => "20"
                        "paginaInicial" => "857"
                        "paginaFinal" => "865"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Locking compression plate fixation of Vancouver type B1 periprosthetic femoral fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;A&#46; Buttaro"
                            1 => "G&#46; Farfalli"
                            2 => "P&#46; Parades N&#250;&#241;ez"
                            3 => "F&#46; Comba"
                            4 => "F&#46; Piccaluga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg"
                        "fecha" => "2007"
                        "volumen" => "89A"
                        "paginaInicial" => "1964"
                        "paginaFinal" => "1969"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Corten"
                            1 => "F&#46; Vanrykel"
                            2 => "J&#46; Bellemans"
                            3 => "P&#46;R&#46; Frederix"
                            4 => "J&#46;P&#46; Simon"
                            5 => "P&#46;L&#46; Broos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg"
                        "fecha" => "2009"
                        "volumen" => "91B"
                        "paginaInicial" => "1424"
                        "paginaFinal" => "1430"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Principles of treatment for periprosthetic femoral shaft fractures around well fixed total hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Pike"
                            1 => "D&#46; Davidson"
                            2 => "D&#46; Garbuz"
                            3 => "C&#46;P&#46; Duncan"
                            4 => "P&#46;J&#46; O&#8217;Brien"
                            5 => "B&#46;A&#46; Masri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Orthop Surg"
                        "fecha" => "2009"
                        "volumen" => "17"
                        "paginaInicial" => "677"
                        "paginaFinal" => "688"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19880678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/19888856/0000005900000005/v1_201508080018/S1988885615000553/v1_201508080018/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7577"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/19888856/0000005900000005/v1_201508080018/S1988885615000553/v1_201508080018/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000553?idApp=UINPBA00004N"
]

Article information

ISSN: 19888856
Original language: English

DOI:10.1016/j.recote.2015.07.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	0	4
2024 October	46	3	49
2024 September	54	7	61
2024 August	39	8	47
2024 July	67	5	72
2024 June	58	2	60
2024 May	100	8	108
2024 April	65	12	77
2024 March	79	10	89
2024 February	91	12	103
2024 January	86	14	100
2023 December	103	19	122
2023 November	123	15	138
2023 October	114	8	122
2023 September	63	9	72
2023 August	55	3	58
2023 July	113	8	121
2023 June	72	3	75
2023 May	82	7	89
2023 April	96	8	104
2023 March	59	6	65
2023 February	60	0	60
2023 January	77	10	87
2022 December	49	16	65
2022 November	63	9	72
2022 October	63	8	71
2022 September	54	6	60
2022 August	48	14	62
2022 July	43	8	51
2022 June	47	13	60
2022 May	44	10	54
2022 April	49	9	58
2022 March	32	4	36
2022 February	25	8	33
2022 January	39	8	47
2021 December	25	11	36
2021 November	36	10	46
2021 October	33	14	47
2021 September	65	8	73
2021 August	32	5	37
2021 July	6	4	10
2021 June	26	9	35
2021 May	13	6	19
2021 April	34	14	48
2021 March	14	6	20
2021 February	15	8	23
2021 January	18	4	22
2018 February	15	0	15
2018 January	3	0	3
2017 December	4	0	4
2017 November	8	0	8
2017 October	5	0	5
2017 September	10	1	11
2016 February	0	1	1
2015 October	0	1	1
2015 August	0	1	1

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter