Early experience with the use of trochanteric reattachment plate for the treatment of Vancouver type B 1 periprosthetic hip fractures

Abstract

Objective: The purpose of our study is to study the usefulness of trochanteric reattachment plate in the management Vancouver type B 1 periprosthetic femur fractures. Methods: We describe a case series of 15 (12 F: 3 M) Vancouver type B 1 fracture fixed with trochanteric reattachment plate with 3 years follow up. Patients with Vancouver A, B2, B3 and C fractures were excluded in the study. Clinical and radiological assessment of patients was done at 1, 3, 6, 9, 12, 24 and 36 months. The parameters evaluated were fracture union, Harris hip score and post-operative complications if any. Results: Patients mean age was 74 years (range 58e84). Eleven patients were operated with cemented hemiarthroplasty while 4 patients had total hip arthroplasty done before. Operation time mean was 137.2 min and mean surgical blood loss was 522.66 ml. All the patients achieved radiological union of the fracture at mean of 14.13 weeks. Mean Harris hip Score was 82 at 36 months follow up. 13 out of 15 hips (86.67%) showed good clinical results and 2 patients (13.33%) showed fair result. All the patients returned to their pre injury activities of daily living. Conclusion: Operative fixation of Vancouver type B 1 periprosthetic fractures is a challenge for an orthopedic surgeon. Open reduction and internal fixation of these fractures using of trochanteric reattachment plate incorporating screws and cerclage wires through the plate provides good outcome in these patients. Use of this plate offers the surgeon stability against shearing as well as rotational forces.

Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis

“…Among 39 studies, 10 articles compared the results of Vancouver B1 PFFs treated with ORIF with that of B2 PFFs, and were included in a pair-wise meta-analysis 4 6 7 8 9 16 17 18 21 22) . Twenty-five single cohort studies 1 2 5 20 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43) reported outcomes after surgery for treatment of Vancouver B1 PFFs, and four single cohort studies with Vancouver B2 44 45 46 47) . The studies identified for the meta-analysis included 1,348 femurs: 917 Vancouver B1 PFFs, and 431 Vancouver B2 PFFs ( Table 1 ).…”

“…According to the results of our meta-analysis, the pooled prevalence of reoperation was 9% (95% CI, 6-12) from all studies, which is in agreement with promising results from recent studies 48 56) . In recent decades, there have been significant advancements in orthopedic surgery techniques and implants including management of PFF for elderly patients 5 25 28 33) . Thus, because treatment of PFFs can be challenging, it is important for the surgeon to approach the procedure with confidence and diligence.…”