Buttaro, J Bone Joint Surg Am 2007 - Locking Compression Plate Fixation of Vancouver Type-B1 Periprosthetic Femoral Fractures

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

Buttaro, Piccaluga, et al.·J Bone Joint Surg Am·2007·153 citations·Retrospective cohort

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Background

Fractures occurring at or near the distal tip of a hip prosthesis with a stable femoral stem (Vancouver type-B fractures) are associated with many complications because of the inherently unstable fracture pattern. Locking compression plates use screws that lock into the plate allowing multiple points of unicortical fixation. Such unicortical fixation may lower the risk of damage to the cement mantle or a stable femoral stem during the treatment of a periprosthetic femoral fracture. The purpose of this study was to analyze clinically and radiographically a group of patients with a Vancouver type-B1 periprosthetic femoral fracture treated with open reduction and internal fixation with use of a locking compression plate.

Methods

14 consecutive patients (14 hips) with a Vancouver type-B1 periprosthetic femoral fracture were treated with a locking compression plate.
There were 5 men and 9 women with an average age of 68 years at the time of fracture.
All of the fractures occurred after a total hip arthroplasty performed with cement, and 11 of the arthroplasties were revisions.
In addition to the plate, cortical strut allografts were used to stabilize 5 fractures.
The patients were assessed clinically and radiographically.

Results

The average duration of follow-up was 20 months.
8 fractures healed uneventfully at an average of 5.4 months.
3 treatment constructs failed with fracture of the plate within 12 months after surgery.
An additional 3 constructs also failed because of plate pullout.
All failures except one occurred in constructs in which a cortical strut allograft had not been utilized.

Conclusions

On the basis of the high failure rate in this series of patients, locking compression plates do not appear to offer advantages over other types of plates in the treatment of type-B1 periprosthetic femoral fractures. Despite the potential to preserve the cement mantle, the locked screws did not appear to offer good pullout resistance in this fracture type. We believe that supplementation with strut allografts should be used routinely if this type of locking compression plate is selected to treat these fractures.

Copyright remains with the authors and publisher.

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

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

Buttaro, Piccaluga, et al.·J Bone Joint Surg Am·2007·153 citations·Retrospective cohort

|

Background

Fractures occurring at or near the distal tip of a hip prosthesis with a stable femoral stem (Vancouver type-B fractures) are associated with many complications because of the inherently unstable fracture pattern. Locking compression plates use screws that lock into the plate allowing multiple points of unicortical fixation. Such unicortical fixation may lower the risk of damage to the cement mantle or a stable femoral stem during the treatment of a periprosthetic femoral fracture. The purpose of this study was to analyze clinically and radiographically a group of patients with a Vancouver type-B1 periprosthetic femoral fracture treated with open reduction and internal fixation with use of a locking compression plate.

Methods

14 consecutive patients (14 hips) with a Vancouver type-B1 periprosthetic femoral fracture were treated with a locking compression plate.
There were 5 men and 9 women with an average age of 68 years at the time of fracture.
All of the fractures occurred after a total hip arthroplasty performed with cement, and 11 of the arthroplasties were revisions.
In addition to the plate, cortical strut allografts were used to stabilize 5 fractures.
The patients were assessed clinically and radiographically.

Results

The average duration of follow-up was 20 months.
8 fractures healed uneventfully at an average of 5.4 months.
3 treatment constructs failed with fracture of the plate within 12 months after surgery.
An additional 3 constructs also failed because of plate pullout.
All failures except one occurred in constructs in which a cortical strut allograft had not been utilized.

Conclusions

On the basis of the high failure rate in this series of patients, locking compression plates do not appear to offer advantages over other types of plates in the treatment of type-B1 periprosthetic femoral fractures. Despite the potential to preserve the cement mantle, the locked screws did not appear to offer good pullout resistance in this fracture type. We believe that supplementation with strut allografts should be used routinely if this type of locking compression plate is selected to treat these fractures.

Copyright remains with the authors and publisher.

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