Osteosynthesis in Vancouver type B1 and C Periprosthetic Hip Fractures of the Femur. A Multicenter Analysis
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Published:
Oct 24, 2022
Keywords:
Periprosthetic femoral fractures, osteosynthesis, Vancouver classification
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Abstract
Introduction: Our objective was to analyze the results of osteosynthesis treatment in patients with Vancouver type B1 and C fractures, evaluate complications, reinterventions and the mortality rate in this group.
Materials and Methods: Multicenter, retrospective study. A database was established that included 53 patients with Vancouver type B1 and C periprosthetic femoral fractures treated with osteosynthesis from 2008 to 2021, who were evaluated in two high-complexity hospital centers.
Results: The most used proximal fixation was bicortical screws and wire loops. The type of fracture according to the Vancouver classification correlated with a significant value in the use of interfragmentary compression screws (p 0.001), with a total of 13 patients (24.52%), 9 in Vancouver type C fractures. Mean consolidation was 4 months, with a mean Harris Hip Score of 68. Twelve patients (22.64%) had complications: delayed union (7 cases; 13.2%), failed osteosynthesis with fracture at the distal level of the stem (one case; 1.88%), one new osteosynthesis due to failure at the level of the osteosynthesis material (one case; 1.88%), and three deaths (5.66%).
Conclusions: The management of periprosthetic femoral fractures is a complex and challenging issue. Osteosynthesis treatment is a successful method that requires the application of current principles of minimally invasive techniques that, together with stable proximal fixation, improve the chances of success
Materials and Methods: Multicenter, retrospective study. A database was established that included 53 patients with Vancouver type B1 and C periprosthetic femoral fractures treated with osteosynthesis from 2008 to 2021, who were evaluated in two high-complexity hospital centers.
Results: The most used proximal fixation was bicortical screws and wire loops. The type of fracture according to the Vancouver classification correlated with a significant value in the use of interfragmentary compression screws (p 0.001), with a total of 13 patients (24.52%), 9 in Vancouver type C fractures. Mean consolidation was 4 months, with a mean Harris Hip Score of 68. Twelve patients (22.64%) had complications: delayed union (7 cases; 13.2%), failed osteosynthesis with fracture at the distal level of the stem (one case; 1.88%), one new osteosynthesis due to failure at the level of the osteosynthesis material (one case; 1.88%), and three deaths (5.66%).
Conclusions: The management of periprosthetic femoral fractures is a complex and challenging issue. Osteosynthesis treatment is a successful method that requires the application of current principles of minimally invasive techniques that, together with stable proximal fixation, improve the chances of success
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How to Cite
Aguirre, G. L., Allende, B. L., Pioli, I., Iglesias, S., Pereira, S., Vindver, G., & Bidolegui, F. (2022). Osteosynthesis in Vancouver type B1 and C Periprosthetic Hip Fractures of the Femur. A Multicenter Analysis. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(5), 652-659. https://doi.org/10.15417/issn.1852-7434.2022.87.5.1601
Section
Clinical Research
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References
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PMID: 7797866
3. Malchau H, Herberts P, Eisler T, Garellick G, Söderman P. The Swedish Total Hip Replacement Register. J Bone
Joint Surg Am 2002;84(Suppl 2):2-20. https://doi.org/10.2106/00004623-200200002-00002
4. Pike J, Davidson D, Garbuz D, Duncan CP, O’Brien PJ, Masri BA. Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg 2009;17(11):677-88.
https://doi.org/10.5435/00124635-200911000-00002
5. Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the
femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 2009;33(4):1119-26.
https://doi.org/10.1007/s00264-008-0603-2
6. Sen R, Prasad P, Kumar S, Nagi O. Periprosthetic femoral fractures around well fixed implants: a simple method of fixation using lc-dcp with trochanteric purchase. Acta Orthop Belg 2007;73(2):200-6. PMID: 17515232
7. Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP. Periprosthetic femoral fractures around
well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am 2002;84(6):945-
50. PMID: 12063328
8. Chandler HP, King D, Limbird R, Hedley A, Mccarthy J, Penenberg B, et al. The use of cortical allograft struts for
fixation of fractures associated with well-fixed total joint prostheses. Semin Arthroplasty 1993;4(2):99-107.
PMID: 10148551
9. Emerson RH, Malinin TI, Cuellar AD, Head WC, Peters PC. Cortical strut allografts in the reconstruction of the
femur in revision total hip arthroplasty. A basic science and clinical study. Clin Orthop Relat Res 1992;(285):35-44.
PMID: 1446451
10. Krettek C, Müller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury
2001;32(Suppl 3):14-23. https://doi.org/10.1016/s0020-1383(01)00180-2
11. Perren SM. Evolution of the internal fixation of long bone fractures: the scientific basis of biological internal
fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84-b(8):1093-110.
https://doi.org/10.1302/0301-620x.84b8.13752
12. Perren SM, Cordey J, Rahn BA, Gautier E, Schneider E. Early temporary porosis of bone induced by internal
fixation implants. A reaction to necrosis, not to stress protection? Clin Orthop Relat Res 1988;(232):139-51.
PMID: 3289811
13. Hoffmann MF, Burgers TA, Mason JJ, Williams BO, Sietsema Dl, Jones CB. Biomechanical evaluation of fracture
fixation constructs using a variable-angle locked periprosthetic femur plate system. Injury 2014;45(7):1035-41.
https://doi.org/10.1016/j.injury.2014.02.038
14. Fulkerson E, Egol KA, Kubiak EN, Liporace F, Kummer FJ, Koval KJ. Fixation of diaphyseal fractures with
a segmental defect: a biomechanical comparison of locked and conventional plating techniques. J Trauma
2006;60(4):830-5. https://doi.org/10.1097/01.ta.0000195462.53525.0c
15. Buttaro MA, Farfalli G, Núñez MP, 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. https://doi.org/10.2106/JBJS.F.01224
16. Pavlou G, Panteliadis P, Macdonald D, Timperley JA, Gie G, Bancroft G, et al. A review of 202 periprosthetic
fractures - stem revision and allograft improves outcome for type b fractures. Hip Int 2011;21(1):21-9.
https://doi.org/10.5301/hip.2011.6301
17. Leonidou A, Moazen M, Skrzypiec DM, Graham SM, Pagkalos J, Tsiridis E. Evaluation of fracture topography and bone quality in periprosthetic femoral fractures: a preliminary radiographic study of consecutive clinical data. Injury 2013;44(12):1799-804. https://doi.org/10.1016/j.injury.2013.08.010
18. Schwarzkopf R, Oni JK, Marwin SE. Total hip arthroplasty periprosthetic femoral fractures: a review of
classification and current treatment. Bull Hosp Jt Dis 2013;71(1):68-78. PMID: 24032586
19. Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP--how can stability in
locked internal fixators be controlled? Injury 2003;34(Suppl 2):b11-19. https://doi.org/10.1016/j.injury.2003.09.021
20. Kubiak EN, Haller JM, Kemper DD, Presson AP, Higgins TF, Horwitz DS. Does the lateral plate need to overlap
the stem to mitigate stress concentration when treating Vancouver c periprosthetic supracondylar femur fracture? J Arthroplasty 2015;30(1):104-8. https://doi.org/10.1016/j.arth.2014.07.021
2. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995;44:293-304.
PMID: 7797866
3. Malchau H, Herberts P, Eisler T, Garellick G, Söderman P. The Swedish Total Hip Replacement Register. J Bone
Joint Surg Am 2002;84(Suppl 2):2-20. https://doi.org/10.2106/00004623-200200002-00002
4. Pike J, Davidson D, Garbuz D, Duncan CP, O’Brien PJ, Masri BA. Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg 2009;17(11):677-88.
https://doi.org/10.5435/00124635-200911000-00002
5. Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the
femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 2009;33(4):1119-26.
https://doi.org/10.1007/s00264-008-0603-2
6. Sen R, Prasad P, Kumar S, Nagi O. Periprosthetic femoral fractures around well fixed implants: a simple method of fixation using lc-dcp with trochanteric purchase. Acta Orthop Belg 2007;73(2):200-6. PMID: 17515232
7. Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP. Periprosthetic femoral fractures around
well-fixed implants: use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am 2002;84(6):945-
50. PMID: 12063328
8. Chandler HP, King D, Limbird R, Hedley A, Mccarthy J, Penenberg B, et al. The use of cortical allograft struts for
fixation of fractures associated with well-fixed total joint prostheses. Semin Arthroplasty 1993;4(2):99-107.
PMID: 10148551
9. Emerson RH, Malinin TI, Cuellar AD, Head WC, Peters PC. Cortical strut allografts in the reconstruction of the
femur in revision total hip arthroplasty. A basic science and clinical study. Clin Orthop Relat Res 1992;(285):35-44.
PMID: 1446451
10. Krettek C, Müller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury
2001;32(Suppl 3):14-23. https://doi.org/10.1016/s0020-1383(01)00180-2
11. Perren SM. Evolution of the internal fixation of long bone fractures: the scientific basis of biological internal
fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84-b(8):1093-110.
https://doi.org/10.1302/0301-620x.84b8.13752
12. Perren SM, Cordey J, Rahn BA, Gautier E, Schneider E. Early temporary porosis of bone induced by internal
fixation implants. A reaction to necrosis, not to stress protection? Clin Orthop Relat Res 1988;(232):139-51.
PMID: 3289811
13. Hoffmann MF, Burgers TA, Mason JJ, Williams BO, Sietsema Dl, Jones CB. Biomechanical evaluation of fracture
fixation constructs using a variable-angle locked periprosthetic femur plate system. Injury 2014;45(7):1035-41.
https://doi.org/10.1016/j.injury.2014.02.038
14. Fulkerson E, Egol KA, Kubiak EN, Liporace F, Kummer FJ, Koval KJ. Fixation of diaphyseal fractures with
a segmental defect: a biomechanical comparison of locked and conventional plating techniques. J Trauma
2006;60(4):830-5. https://doi.org/10.1097/01.ta.0000195462.53525.0c
15. Buttaro MA, Farfalli G, Núñez MP, 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. https://doi.org/10.2106/JBJS.F.01224
16. Pavlou G, Panteliadis P, Macdonald D, Timperley JA, Gie G, Bancroft G, et al. A review of 202 periprosthetic
fractures - stem revision and allograft improves outcome for type b fractures. Hip Int 2011;21(1):21-9.
https://doi.org/10.5301/hip.2011.6301
17. Leonidou A, Moazen M, Skrzypiec DM, Graham SM, Pagkalos J, Tsiridis E. Evaluation of fracture topography and bone quality in periprosthetic femoral fractures: a preliminary radiographic study of consecutive clinical data. Injury 2013;44(12):1799-804. https://doi.org/10.1016/j.injury.2013.08.010
18. Schwarzkopf R, Oni JK, Marwin SE. Total hip arthroplasty periprosthetic femoral fractures: a review of
classification and current treatment. Bull Hosp Jt Dis 2013;71(1):68-78. PMID: 24032586
19. Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP--how can stability in
locked internal fixators be controlled? Injury 2003;34(Suppl 2):b11-19. https://doi.org/10.1016/j.injury.2003.09.021
20. Kubiak EN, Haller JM, Kemper DD, Presson AP, Higgins TF, Horwitz DS. Does the lateral plate need to overlap
the stem to mitigate stress concentration when treating Vancouver c periprosthetic supracondylar femur fracture? J Arthroplasty 2015;30(1):104-8. https://doi.org/10.1016/j.arth.2014.07.021