Osteosynthesis in Vancouver type B1 and C Periprosthetic Hip Fractures of the Femur. A Multicenter Analysis
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 successDownloads
References
Mulay S, Hassan T, Birtwistle S, Power R. Management of types b2 and b3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem. J Arthroplasty 2005;20(6):751-6. https://doi.org/10.1016/j.arth.2004.11.020
Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995;44:293-304.
PMID: 7797866
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
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
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
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
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-
PMID: 12063328
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
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
Krettek C, Müller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury
;32(Suppl 3):14-23. https://doi.org/10.1016/s0020-1383(01)00180-2
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
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
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
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
;60(4):830-5. https://doi.org/10.1097/01.ta.0000195462.53525.0c
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
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
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
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
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
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
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