Open Reduction and Locked Compression Plate Fixation, with or Without Allograft Strut, for Periprosthetic Fractures in Patients Who Had a Well-fixed Femoral Stem: a Retrospective Study with an Average 2-year Follow-up

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2022 Jan 20

PMID 35045862

Authors

Hui Lv

Xing Guo

Yuan Hui Wang

Zhong Jie Zhang

Long Fei Zou

Hao Xue

Deng Hua Huang

Mei Yun Tan

Affiliations

Soon will be listed here.

Abstract

Background: The use of cortical strut allograft has not been determined for Vancouver type B1 or C fracture. This study aimed to evaluate the short-term efficacy of locking compression plating with or without cortical strut allograft in managing these types of fractures.

Methods: We retrospectively assessed 32 patients (17 males, 15 females; 23-88 years, mean: 67.2 years) with Vancouver type B1 or C fractures. Seventeen patients (Group A; B1 fractures in 15 hips, C fractures in 2 hips) were treated with open reduction and internal fixation with locking compression plates (group A). The other 15 patients (Group B; B1 in 14 hips, C in 1 hip) were fixed by locking compression plating combined with cortical strut allografting (group B). The fracture healing rate, healing time, complications and function were compared between these two groups.

Results: The mean follow-up time was 32.4 months (12 to 66), and the overall fracture union rate of the 32 patients was 96.9%. Group B had a higher fracture union rate than Group A, but the difference was not statistically significant. Group A had one case of nonunion of type B1 fracture and one case of malunion; the mean time to fracture healing was 5.3 months (3 to 9). In group B, all patients reached bony union without malunion, with a mean time of fracture healing of 5.1 months (3 to 8).

Conclusion: Treatment of Vancouver type B1 or C fractures by locking compression plating, with or without cortical strut allografting, resulted in similar union rates in these patients. This suggest that, the use of cortical strut allografting should be decided cautiously.

Citing Articles

Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures: Insights from a Comprehensive Case Series Analysis.

Cursaru A, Popa M, Cretu B, Iordache S, Iacobescu G, Spiridonica R Cureus. 2024; 16(1):e53269.

PMID: 38435949 PMC: 10905061. DOI: 10.7759/cureus.53269.

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

Yoon B, Park S, Roh Y Hip Pelvis. 2023; 35(4):217-227.

PMID: 38125267 PMC: 10728046. DOI: 10.5371/hp.2023.35.4.217.

Cortical allograft strut augmented with platelet-rich plasma for the treatment of long bone non-union in lower limb- a pilot study.

Wu S, Quan K, Mei J, Dai M, Song S BMC Musculoskelet Disord. 2022; 23(1):512.

PMID: 35637466 PMC: 9150336. DOI: 10.1186/s12891-022-05375-w.

References

Fleischman A, Chen A . Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls. Ann Transl Med. 2015; 3(16):234. PMC: 4598449. DOI: 10.3978/j.issn.2305-5839.2015.09.32. View

Pike J, Davidson D, Garbuz D, Duncan C, OBrien P, Masri B . Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg. 2009; 17(11):677-88. DOI: 10.5435/00124635-200911000-00002. View

Rollo G, Bonura E, Huri G, Ronga M, Carulli C, Bisaccia M . Standard plating vs. cortical strut and plating for periprosthetic knee fractures: a multicentre experience. Med Glas (Zenica). 2019; 17(1):170-177. DOI: 10.17392/1035-20. View

Graham S, Moazen M, Leonidou A, Tsiridis E . Locking plate fixation for Vancouver B1 periprosthetic femoral fractures: a critical analysis of 135 cases. J Orthop Sci. 2013; 18(3):426-36. DOI: 10.1007/s00776-013-0359-4. View

Hoffmann M, Lotzien S, Schildhauer T . Outcome of periprosthetic femoral fractures following total hip replacement treated with polyaxial locking plate. Eur J Orthop Surg Traumatol. 2016; 27(1):107-112. DOI: 10.1007/s00590-016-1851-2. View

Boesmueller S, Baumbach S, Hofbauer M, Wozasek G . Plate failure following plate osteosynthesis in periprosthetic femoral fractures. Wien Klin Wochenschr. 2015; 127(19-20):770-8. DOI: 10.1007/s00508-015-0818-3. View

Haddad F . Periprosthetic fractures: more challenges ahead. Bone Joint J. 2020; 102-B(5):547-549. DOI: 10.1302/0301-620X.102B5.BJJ-2020-0427. View

Ding Z, Ling T, Mou P, Wang D, Zhou K, Zhou Z . Bone restoration after revision hip arthroplasty with femoral bone defects using extensively porous-coated stems with cortical strut allografts. J Orthop Surg Res. 2020; 15(1):194. PMC: 7254662. DOI: 10.1186/s13018-020-01720-8. View

Buttaro M, Farfalli G, Paredes Nunez M, Comba F, Piccaluga F . Locking compression plate fixation of Vancouver type-B1 periprosthetic femoral fractures. J Bone Joint Surg Am. 2007; 89(9):1964-9. DOI: 10.2106/JBJS.F.01224. View

10.

Old A, McGrory B, White R, Babikian G . Fixation of Vancouver B1 peri-prosthetic fractures by broad metal plates without the application of strut allografts. J Bone Joint Surg Br. 2006; 88(11):1425-9. DOI: 10.1302/0301-620X.88B11.17749. View

11.

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. J Bone Joint Surg Am. 2005; 87(10):2240-5. DOI: 10.2106/JBJS.D.01911. View

12.

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

13.

Li D, Hu Q, Kang P, Yang J, Zhou Z, Shen B . Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft. Int Orthop. 2018; 42(12):2787-2795. DOI: 10.1007/s00264-018-3997-5. View

14.

Zheng H, Gu H, Shao H, Huang Y, Yang D, Tang H . Treatment and outcomes of Vancouver type B periprosthetic femoral fractures. Bone Joint J. 2020; 102-B(3):293-300. DOI: 10.1302/0301-620X.102B3.BJJ-2019-0935.R1. View

15.

Delaunay C, Hamadouche M, Girard J, Duhamel A . What are the causes for failures of primary hip arthroplasties in France?. Clin Orthop Relat Res. 2013; 471(12):3863-9. PMC: 3825891. DOI: 10.1007/s11999-013-2935-5. View

16.

Carta S, Fortina M, Riva A, Meccariello L, Manzi E, Di Giovanni A . The Biological Metallic versus Metallic Solution in Treating Periprosthetic Femoral Fractures: Outcome Assessment. Adv Med. 2016; 2016:2918735. PMC: 5136380. DOI: 10.1155/2016/2918735. View

17.

Kim Y, Mansukhani S, Kim J, Park J . Use of Locking Plate and Strut Onlay Allografts for Periprosthetic Fracture Around Well-Fixed Femoral Components. J Arthroplasty. 2016; 32(1):166-170. DOI: 10.1016/j.arth.2016.05.064. View

18.

Rollo G, Tartaglia N, Falzarano G, Pichierri P, Stasi A, Medici A . The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut. Eur J Trauma Emerg Surg. 2017; 43(6):853-861. DOI: 10.1007/s00068-016-0755-5. View

19.

Giganti M, Tresoldi I, Masuelli L, Modesti A, Grosso G, Liuni F . Fracture healing: from basic science to role of nutrition. Front Biosci (Landmark Ed). 2014; 19(7):1162-75. DOI: 10.2741/4273. View

20.

Lindahl H, Malchau H, Oden A, Garellick G . Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br. 2005; 88(1):26-30. DOI: 10.1302/0301-620X.88B1.17029. View