Cable plate fixation for Vancouver Type-B1 periprosthetic femoral fractures-Our experience and identification of a subset at risk of non-union

Chakrabarti, Dip; Thokur, Niyamathullah; Ajnin, Serajdin

doi:10.1016/j.injury.2019.10.012

Cited by 22 publications

(20 citation statements)

References 20 publications

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“…Some of these biological criteria can link each other (for example: an atypical pattern of fracture seems more frequent in osteoporotic patients on long lasting BPs therapy) and can coexist. As for cemented stems, in our opinion it is more a biological issue than a mechanical one: an overlooked failure of the stem-cemented interface has been advocate as a mechanical cause of failure in PFFs around a cemented stem [29,76] but a reduce capability of bone healing (less viable area, no endosteal callus formation) and an absent opportunity for re-osteointegration are biological issues that are undoubtedly present. Alike, a transverse fracture at the tip of the stem has always been considered a mechanical problem but it also implies biological issues (less surface for bone healing).…”

Section: Discussionmentioning

confidence: 99%

“…Anyway, mechanical elements are not the only factors that should indicate the use of a structural allograft, and biological issues has to be taken into account, as well. A PFF around or at the tip of a cemented stem [20,75,76] or over an osteoporotic bone are known to have higher complication rate than other cases [77]. Conditions such as osteoporosis and rheumatoid arthritis or other autoimmune or endocrinological diseases, long lasting CCSs or BPs assumption, AFFs or previous surgeries are indicators of a local and systemic biological impairment that suggest the use of structural allograft even if mechanically it would be unnecessary [6,9,31,78].…”

Section: Discussionmentioning

confidence: 99%

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Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Mondanelli

Colasanti

Cataldi

et al. 2020

Preprint

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Background: There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Based on our experience in the treatment of nonunions after PFFs and other challenging cases and on Literature, we propose an algorithm that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem.Methods: We retrospectively reviewed data on patients who failed to heal after a surgically treated Vancouver type B1 or C PFF. All patients were treated with locking plate, double structural allograft and autologous bone marrow concentrate (BMC) over a platelet-rich plasma (PRP)-based membrane at fracture site. All patients were also pharmacologically treated with Teriparatide in the postoperative period. We studied patients with radiograms, histological evaluation of the nonunion area, and phosphocalcic metabolism. Patients were assessed subjectively, clinically and radiographically until healing and then annually.Results: All nonunions healed over a six months period, and functional recovery appeared to be good. Retrospective evaluation of the proposed algorithm showed that none of the patients met biological or mechanical criteria such as to make valid the treatment with locking plate alone.Conclusion: Mechanical factors are not the only issues that should be taken into account when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions are factors that should drive to a rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous BMC in a PRP-based scaffold) and systemic anabolic treatment (Teriparatide) in the first instance. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, taking into account mechanical and biological criteria.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Mondanelli

Colasanti

Cataldi

et al. 2020

Preprint

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“…Mortality in our cohort was 12.9%, that is in line with the reported data of Literature. 8,21 Limitations of this study are inherent to the retrospective collection of data, the non-randomised nature, the small sample of patients and a lack of a control group.…”

Section: Discussionmentioning

confidence: 99%

“…This data is in line with recent literature. 8,[10][11][12] In a critical analysis of the literature Graham et al 10 have identified 3 common reasons for failure: (1) screw pull-out; (2) bone fractures at the end of the plate due to stress raiser; (3) fracture across empty screw holes.…”

Section: Discussionmentioning

confidence: 99%

“…Fracture union was defined as the ability of the patient to weight bear fully with or without aids and having radiological evidence of callus bridging of the fracture on both AP and lateral radiographic views. 8 Patients with Vancouver B1 fractures were divided into 2 subgroups: Group B1-L, in which the fracture line was long-spiral or oblique, running along the body of the stem; Group B1-S with a transverse or short-oblique fracture line, occurring closer to the tip of the stem.…”

Section: Methodsmentioning

confidence: 99%

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The management of Vancouver B1 and C periprosthetic fractures: radiographic and clinic outcomes of a monocentric consecutive series

Ciriello¹,

Chiarpenello²,

Tomarchio³

et al. 2020

HIP International

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Introduction: Periprosthetic fractures (PFs) are a main complication after total hip arthroplasty (THA), with rising incidence. The optimal treatment of PFs is still being debated in the literature. Historically, high failure and reoperation rates are reported, although the introduction of locking plates has led to improved results. In this study we report clinical and radiographic outcomes of a consecutive series of Vancouver B1 and C fractures, treated with a novel type of locking plate. We also aim to identify the variables associated with healing time. Methods: Between June 2013 and May 2019, 47 patients were consecutively admitted to the Emergency Department of our Hospital with a diagnosis of PF around a well-fixed THA stem. 31 patients fulfilled the inclusion criteria and were included in the study. All patients underwent osteosynthesis with a novel type of plate (“Ironlady” Intrauma, Rivoli, Italy) through a distally extended posterolateral approach. All surgical procedures were performed with the aim of reducing the rigidity of the fixation construct and preserving periosteal vitality. Demographic data, type of fracture, type of stem and its fixation, surgical details, and clinical and radiographical outcomes were recorded. Each variable was investigated to assess its relationship with fracture healing and healing time. Results: 31 patients were included in the study. 4 patients died before the minimum follow-up of 6 months and were excluded from the series. The final sample consisted of 27 patients. Their median age at operation was 84.8 years (range 65.3–95.4 years); 21 were female. The median follow-up after surgery was 2.36 years (range 6 months–4.7 years). In the cohort there were 22 type Vancouver B1 fractures (81.5%) and 5 type C (18.5%). All fractures occurred postoperatively (no acute intraoperative fractures). Fracture union was achieved in 26 patients (96.3%). The following variables were found to be associated with increased healing time: Vancouver type of fracture, pattern of Vancouver B1 fracture type, age and male gender. Conclusions: On the base of our results, the management of Vancouver B1 and C type of PFs by locking plate osteosynthesis appears to be a safe and effective procedure. To enhance healing and reduce complication rate, accurate surgical technique is required, aiming to implement the proximal fixation, avoid stress rising, reduce rigidity of the osteosynthesis construct and preserve the plate-to-bone gap.

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Periprosthetic Fracture After Total Hip Arthroplasty

Nayak,

Rambani

2023

Hip Arthroplasty

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Cable plate fixation for Vancouver Type-B1 periprosthetic femoral fractures-Our experience and identification of a subset at risk of non-union

Cited by 22 publications

References 20 publications

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

The management of Vancouver B1 and C periprosthetic fractures: radiographic and clinic outcomes of a monocentric consecutive series

Periprosthetic Fracture After Total Hip Arthroplasty

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