Dynamic compression plates for Vancouver type B periprosthetic femoral fractures

Abstract

Background There is no consensus on the best surgical treatment of periprosthetic femoral fractures. We report our experience with a dynamic compression plate.Patients and methods We reviewed the results of 18 periprosthetic femoral fractures treated with open reduction and internal fixation using the dynamic compression plate (DCP). There were 7 Vancouver type B1, 2 type B2 and 9 type B3 fractures. 16 cases had previously undergone at least one revision procedure. In addition to a DCP plate, all B2 and B3 fractures were revised to cemented prostheses, and all B3 fractures were revised with impaction grafting. Mean follow-up was 39 months.Results The mean healing time for those 11 cases that united was 13 months. One B1-type and one B3-type fracture with plate fracture within 8 months of surgery failed to heal. Furthermore, one B1-type fracture and one B2-type fracture failed and developed nonunion. 3 patients died, from causes not related to surgery, within 8 months after surgery without signs of healing.Interpretation Open reduction and internal fixation using DCPs seems to be a valid method for the treatment of postoperative periprosthetic femoral fractures with stable stem in place. If the stem is unstable, we suggest that DCPs may be used in association with femoral revision using a long stem. In cases with stable stem (B1), we are inclined to agree with other authors that additional fixation using an extramedullary cortical strut graft may be necessary to improve stability and promote final healing.

Locking Compression Plate Fixation of Vancouver Type-B1 Periprosthetic Femoral Fractures

“…The inherently unstable Vancouver type-B1 periprosthetic fracture is especially challenging in hip arthroplasty performed with cement, which was the type of femoral stem fixation used in all fourteen of these patients. Several authors have reported a union rate ranging from 33% to 100% with different surgical approaches 6,8,9,[14][15][16][17][18] . The loss of endosteal healing potential and the soft-tissue stripping required for the placement of struts, wires, and plates could have played an important role in the failures in this series.…”

Management of late periprosthetic femur fractures: a retrospective cohort of 72 patients

“…Despite different classification systems and treatment methods, the ideal solution for this entity has always been a dilemma [7]. In recent years great advances in prosthetic designs such as distal locking modular revision prosthesis, fixed angle locking plates, and usage of cortical onlay grafts have improved the outcomes of these fractures [6,11,18,19]. Our study examined the demography, patterns of fracture, treatment modalities and rate of failure in patients having operative treatment for postoperative periprosthetic fracture of femur.…”

Fixation of Vancouver B1 peri-prosthetic fractures by broad metal plates without the application of strut allografts

“…2 These authors and others have suggested that plates may be used, but only in addition to allograft strut fixation. 2,4,[13][14][15][16] We have demonstrated that when bone stock is sufficient, as generally occurs in Vancouver type-B1 fractures, broad metal plate fixation without bone graft is as good as allograft strut fixation and may be preferable. Accurate reduction and stable fixation, with preservation of the blood supply and timely functional rehabilitation, lead to a high rate of early union.…”

“…Some authors have pointed out several theoretical concerns about plating alone for fixation of peri-prosthetic fractures. 2,4,[13][14][15][16] There may be limited space for screws around the implant proximally, and this may be worse with large canal-filling, uncemented femoral components. 1,9 It has been postulated that screw fixation may damage the cement mantle around a cemented femoral component, produce adverse stress risers around the screws and cause stress shielding under the plate and damage to the stem.…”