case_images: PMC6421721_01
case_images: Anteroposterior pelvis radiograph showing a noncomminuted transverse fracture located at the tip of the stem with localized periosteal thickening of the lateral cortex, or a "beak sign," of the left femur.
case_images: CRIS2019-9845320.001.jpg
case_images: PMC6421721_01_CRIS2019-9845320.001.jpg
case_images: fig1
case_images: An 81-year-old woman with a left bipolar hemiarthroplasty performed 10 years previously presented with a left femoral shaft fracture that occurred without trauma (Figure 1). After the injury, radiographs showed a noncomminuted transverse fracture located at the tip of the stem with localized periosteal thickening of the lateral cortex or a "beak sign"; we judged Vancouver type B1 periprosthetic fracture (Figure 1).
case_images: Anteroposterior pelvis radiograph taken two years prior showed that the femoral stem was in contact with the lateral side of the femur; there was no evidence of fractures and localized periosteal thickening of the lateral cortex slightly emerging in the same area.
case_images: CRIS2019-9845320.002.jpg
case_images: PMC6421721_01_CRIS2019-9845320.002.jpg
case_images: fig2
case_images: Radiographs showed no evidence of a fracture, but slight localized periosteal thickening of the lateral cortex was observed (Figure 2).
case_images: Magnified anteroposterior radiographs of the fracture line, showing gradual clarification of the fracture at six-month follow-up (a), one-year follow-up (b), and two-year follow-up (c).
case_images: CRIS2019-9845320.003.jpg
case_images: PMC6421721_01_CRIS2019-9845320.003.jpg
case_images: fig3
case_images: However, at 24 months (10 days before the injury), the patient reported pain (Figure 3).
case_images: Anteroposterior radiographs showing fixation of the periprosthetic fracture using a cable-plate device (a) after the operation, (b) at one-year follow-up, and (c) at two-year follow-up.
case_images: CRIS2019-9845320.004.jpg
case_images: PMC6421721_01_CRIS2019-9845320.004.jpg
case_images: fig4
case_images: We used a locking plate with cable grip to perform open reduction and internal fixation (Figure 4(a)). One year later, radiographs revealed nonunion (Figure 4(b)). At the two-year follow-up, complete bone union was achieved (Figure 4(c)).
case_images: PMC6421721_02
case_images: Radiograph showing a noncomminuted transverse fracture located at the tip of the well-fixed femoral stem with a medial spike, third bone fragment.
case_images: CRIS2019-9845320.005.jpg
case_images: PMC6421721_02_CRIS2019-9845320.005.jpg
case_images: fig5
case_images: We judged Vancouver type B1 periprosthetic fracture (Figure 5).
case_images: (a) Anteroposterior radiograph, (b) mediolateral radiograph, and (c) magnified anteroposterior radiographs of the fracture line. Five months before hospitalization, the cortical bone was thinning slightly in proximity to the tip of the stable femoral stem and the transverse lucency was admitted on the outside.
case_images: CRIS2019-9845320.006.jpg
case_images: PMC6421721_02_CRIS2019-9845320.006.jpg
case_images: fig6
case_images: In the radiographs taken five months before hospitalization, the cortical bone appeared to be thinning slightly in proximity to the tip of the stable femoral stem and the transverse lucency was emitted on the outside (Figure 6), which resulted in a complete fracture from the incomplete fracture.
case_images: Anteroposterior radiograph showed fixation of the periprosthetic fracture using a cable-plate device following the operation.
case_images: CRIS2019-9845320.007.jpg
case_images: PMC6421721_02_CRIS2019-9845320.007.jpg
case_images: fig7
case_images: We used a locking plate with cable grip to perform open reduction and internal fixation (Figure 7).