Minimally Invasive Periprosthetic Plate Osteosynthesis Using the Locking Attachment Plate

Objective: Stable fixation of periprosthetic or periimplant fractures with an angular stable plate and early weight bearing as tolerated.

Indications: Periprosthetic femur fractures around the hip, Vancouver type B1 or C. Periprosthetic femur and tibia fractures around the knee. Periprosthetic fractures of the humerus. Periimplant fractures after intramedullary nailing.

Contraindications: Loosening of prosthesis. Local infection. Osteitis.

Surgical Technique: Preoperative planning is recommended. After minimally invasive fracture reduction and preliminary fixation, submuscular insertion of a large fragment femoral titanium plate or a distal femur plate. The plate is fixed with locking head screws and/or regular cortical screws where possible. If stability is insufficient, one or two locking attachment plates (LAP) are mounted to the femoral plate around the stem of the prosthesis. After fixing the LAP to one of the locking holes of the femoral plate, 3.5 mm screws are used to connect the LAP to the cortical bone and/or cement mantle of the prosthesis.

Postoperative Management: Weight bearing as tolerated starting on postoperative day 1 is suggested under supervision of a physiotherapist.

Results: In 6 patients with periprosthetic fractures and 2 patients with periimplant fractures, no surgical complications (e.g., wound infection or bleeding) were observed. The mean time to bony union was 14 weeks. No implant loosening of the locking attachment plate was observed. At the follow-up examination, all patients had reached their prefracture mobility level.