PURPOSE: To determine the treatment results according to the guideline of the Vancouver classification in periprosthetic femoral fractures. MATERIALS AND METHODS: Thirty-five periprosthetic femoral fractures treated between May 1981 and February 2003 were assessed. The mean age of the patients was 56 years (30-83 years). The outcomes were estimated according to the Beals and Tower's criteria. RESULTS: The overall incidence of postoperative periprosthetic femoral fracture was 0.91%. The frequency of the fracture types in decreasing order was B1, B2, B3, C, AG and AL. The treatment outcomes according to the Vancouver guidelines were excellent in 27 hips, good in 5 hips and poor in 3 hips. Suspicious risk factors of periprosthetic fractures were found in 6 hips (osteoporosis in 4 hips, osteolysis in 1 hip and loosening of femoral stem in 1 hip). Complications related to the treatment included a bony defect in 1 hip and an infection with non-union in 1 hip. The complications related to treatment for an implant were loosening in 2 hips and subsidence of stem in 1 hip. CONCLUSION: In order to obtain favorable results, in addition to following the Vancouver treatment guideline, consideration should be made to the basic principles such as the stability of the fractures, the stability of the implant and restoration of the bone stock.
Incidence ; Risk Factors

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*