The Unified Classification System applied to the management of periprosthetic fractures after Motec ® total wrist arthroplasty

Abstract

Introduction:

As the use of total wrist replacements increases there is an inevitable increase in periprosthetic fractures, as has been observed in other joint replacements. Lower limb arthroplasty surgeons have adopted the Unified Classification System to help classify and manage periprosthetic fractures around hip and knee replacements. In this paper, we demonstrate how the same classification can be used for fractures around wrist replacements.

Methods:

A retrospective review of prospectively collected data was performed, analysing all periprosthetic fractures treated in four arthroplasty units in two European countries. All fractures were classified using the Unified Classification System and their management and outcome were recorded.

Results:

Twenty-two periprosthetic fractures were identified. The fractures occurred in 10 females and 12 males, aged between 44 and 84 years. At presentation there were one type A fracture, 18 type B (12 B1, three B2 and three B3), one type C and two type F. Type A fractures and undisplaced type C fractures were successfully managed non-operatively. Undisplaced B1 fractures tended not to heal with non-operative management and progressed to B2 or B3. B1 fractures treated with plate fixation around the implant achieved good results. Type B2 and B3 fractures required revision surgery but, in most cases, resulted in a functioning arthroplasty.

Conclusion:

We advocate the use of the Unified Classification System to guide management of periprosthetic fractures around Motec implants. Revision surgery is challenging, and we recommend that the more complex B3, and possibly B2, fractures be managed in specialist units.

Level Evidence:

III