INCIDENCE OF IATROGENIC CALCAR FRACTURES IN HIP HEMIARTHOPLASTY.

Abstract

Objective: To identify the incidence of iatrogenic fractures in hip hemiarthroplasty and identifying
technical errors and how to deal with the complication. Materials and Methods: This is prospective
cohort study in which we analyzed patients who had hemiarthroplasty with un cemented Austin moore&
cemented bipolar endoprosthesis conducted at Liaquat National Hospital Karachi Sindh with particular
reference to intra operative errors associated with iatrogenic calcar fracture and change in the plan of
management with stable fixation. Data was analysed using SPSS version 21. Results: Total 175 were
proceeded with hemiarthroplasty of hip out of which 9(5.1%) patients had intra-operative calcar fracture 6
AMP(3.4%) + 3 Bipolar HA(1.7%).Different intra-operative errors were noted during the
surgeries.Inadequate soft tissue clearance in 27 (15.4%), incorrect cutting neck length in 19 (10.8%) cases,
Incorrect head size 11 (6.2%). inadequate calcar seating in 3(1.7%). Improper cementing technique in 2
(1.1%) cases. 4(2.2%)Intraoperative calcar fractures in AMP were converted to cemented bipolar HA and
cerclage wire was applied and 2(1.1%) AMP were proceeded with cerclage wire and considered stable.Out
of 175 hemiarthoplasties 30(17.14%) patients stated no pain 85(48.57%) stated mild pain and 40(22.85%)
stated moderate pain and 20 (11.42%) complained of severe pain.Radiological assessment stratified 2
patients had subsidence of the stem> 3 mm, 5 patients had signs of loosening of implant confirmed by
bone scan and MRI, 3 patientsacetabular protrusion and/or erosions, no one had heterotopic ossification 4
had dislocations. Conclusion: Hip surgeries always have been demanding specially hemiarthroplasties
which needs expertise in particular field to avoid intraoperative complications and avoiding a technical
error which causes change in the plan of management.