Prognostic Factors and Clinical Outcomes After Treatment of Periprosthetic Femoral Fractures Using a Cable-plate

Overview

Journal Hip Pelvis

Date 2019 Sep 11

PMID 31501766

Citations 1

Authors

Joon Soon Kang

Kyoung-Ho Moon

Bong Sung Ko

Tae Hoon Roh

Yeop Na

Yung-Hun Youn

Joo Hyun Park

Affiliations

Soon will be listed here.

Abstract

Purpose: To analyze prognostic factors for the treatment of periprosthetic femoral fractures (PFFs) using the cable-plate construct.

Materials And Methods: A retrospective review of a consecutive series of 41 PFFs treated by osteosynthesis using the cable-plate system. The mean age of patients was 67.3±12.1 years (range, 42-86 years) and the mean follow-up period was 31.5±11.6 months (range, 12-58 months). Fresh frozen cortical strut allografts were leveraged in three cases for additional stability. Prognostic factors that may potentially affect clinical outcomes were analyzed.

Results: At the time of final follow-up, fracture union was obtained in 29 hips (70.7%; Group I) after an average of 13.5 weeks (range, 12-24 weeks). Healing failure after surgical treatment was observed in 12 cases (29.3%; Group II), including delayed union (n=10) cases and nonunion (n=2). Factors significantly associated with fracture union included fracture pattern (=0.040), plate overlap percentage to stem length (<0.001) and T-score at the preoperative bone mineral density (=0.011). Transverse-type fractures around or just distal to a well-fixed femoral stem were observed in six cases (50.0%) of Group II.

Conclusion: The cable-plate osteosynthesis of PFFs should be performed with caution in transverse-type fractures or in cases with severe osteoporosis. Fixation with sufficient plate overlap to stem length may be critical to prevent healing failure.

Citing Articles

Current Incidence and Future Projection of Periprosthetic Fractures in South Korea: A Study Based on National Claim Database.

Park J, Won S, Kim H, Won S, Lee Y, Koo K Orthop Surg. 2022; 14(3):530-535.

PMID: 35098681 PMC: 8927022. DOI: 10.1111/os.13219.

References

Tadross T, Nanu A, BUCHANAN M, Checketts R . Dall-Miles plating for periprosthetic B1 fractures of the femur. J Arthroplasty. 2000; 15(1):47-51. DOI: 10.1016/s0883-5403(00)91129-x. View

Brady O, Garbuz D, Masri B, Duncan C . The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty. 2000; 15(1):59-62. DOI: 10.1016/s0883-5403(00)91181-1. View

Kelley . Periprosthetic Femoral Fractures. J Am Acad Orthop Surg. 1994; 2(3):164-172. DOI: 10.5435/00124635-199405000-00005. View

Dennis M, Simon J, Kummer F, Koval K, DiCesare P . Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty. 2000; 15(4):523-8. DOI: 10.1054/arth.2000.4339. View

Dennis M, Simon J, Kummer F, Koval K, Di Cesare P . Fixation of periprosthetic femoral shaft fractures: a biomechanical comparison of two techniques. J Orthop Trauma. 2001; 15(3):177-80. DOI: 10.1097/00005131-200103000-00005. View

Schutz M, Muller M, Krettek C, Hontzsch D, Regazzoni P, Ganz R . Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases. Injury. 2002; 32 Suppl 3:SC48-54. DOI: 10.1016/s0020-1383(01)00183-8. View

Kolb W, Guhlmann H, Friedel R, Nestmann H . [Fixation of periprosthetic femur fractures with the less invasive stabilization system (LISS)--a new minimally invasive treatment with locked fixed-angle screws]. Zentralbl Chir. 2003; 128(1):53-9. DOI: 10.1055/s-2003-37320. View

Learmonth I . The management of periprosthetic fractures around the femoral stem. J Bone Joint Surg Br. 2004; 86(1):13-9. View

Howell J, Masri B, Garbuz D, Greidanus N, Duncan C . Cable plates and onlay allografts in periprosthetic femoral fractures after hip replacement: laboratory and clinical observations. Instr Course Lect. 2004; 53:99-110. View

10.

Wilson D, Frei H, Masri B, Oxland T, Duncan C . A biomechanical study comparing cortical onlay allograft struts and plates in the treatment of periprosthetic femoral fractures. Clin Biomech (Bristol). 2004; 20(1):70-6. DOI: 10.1016/j.clinbiomech.2004.08.008. View

11.

Serocki J, Chandler R, Dorr L . Treatment of fractures about hip prostheses with compression plating. J Arthroplasty. 1992; 7(2):129-35. DOI: 10.1016/0883-5403(92)90005-b. View

12.

Lindahl H, Malchau H, Herberts P, Garellick G . Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005; 20(7):857-65. DOI: 10.1016/j.arth.2005.02.001. View

13.

Lindahl H, Garellick G, Regner H, Herberts P, Malchau H . Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am. 2006; 88(6):1215-22. DOI: 10.2106/JBJS.E.00457. View

14.

Ricci W, Bolhofner B, Loftus T, Cox C, Mitchell S, Borrelli Jr J . Indirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant. Surgical Technique. J Bone Joint Surg Am. 2006; 88 Suppl 1 Pt 2:275-82. DOI: 10.2106/JBJS.F.00327. View

15.

Lindahl H . Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007; 38(6):651-4. DOI: 10.1016/j.injury.2007.02.048. View

16.

Corten K, Vanrykel F, Bellemans J, Frederix P, Simon J, Broos P . An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br. 2009; 91(11):1424-30. DOI: 10.1302/0301-620X.91B11.22292. View

17.

Ehlinger M, Adam P, Moser T, Delpin D, Bonnomet F . Type C periprosthetic fractures treated with locking plate fixation with a mean follow up of 2.5 years. Orthop Traumatol Surg Res. 2010; 96(1):44-8. DOI: 10.1016/j.rcot.2009.11.002. View

18.

Xue H, Tu Y, Cai M, Yang A . Locking compression plate and cerclage band for type B1 periprosthetic femoral fractures preliminary results at average 30-month follow-up. J Arthroplasty. 2010; 26(3):467-471.e1. DOI: 10.1016/j.arth.2010.03.031. View

19.

Lever J, Zdero R, Nousiainen M, Waddell J, Schemitsch E . The biomechanical analysis of three plating fixation systems for periprosthetic femoral fracture near the tip of a total hip arthroplasty. J Orthop Surg Res. 2010; 5:45. PMC: 2914750. DOI: 10.1186/1749-799X-5-45. View

20.

Park S, Kim Y, Kim S . Treatment of periprosthetic femoral fractures in hip arthroplasty. Clin Orthop Surg. 2011; 3(2):101-6. PMC: 3095779. DOI: 10.4055/cios.2011.3.2.101. View