OTA 2006 Posters
Scientific Poster #106 Geriatrics
Isolated Locked Plating of Periprosthetic Femoral Fractures Associated
with Stable Hip Arthroplasties
Ginger K. Bryant, MD (n); Julie Agel, MA, ATC (n);
Sean E. Nork, MD (n); David P. Barei, MD, FRCSC (n);
Lisa A. Taitsman, MD, MPH (n); M. Bradford Henley, MD, MBA (n);
Harborview Medical Center, Seattle, Washington, USA
Purpose: The incidence of periprosthetic femoral fractures in patients
with hip arthroplasties is anticipated to increase as the age and activity
level of the arthroplasty population rises. Due to the associated osteopenia
and limited fixation strength of conventional implants in these patients,
allograft struts, cerclage cables, or combinations thereof have been recommended
for the treatment of periprosthetic femoral fractures. The purpose of this
study is to report treatment results of periprosthetic femoral fractures
adjacent or distal to a stable femoral prosthetic stem (Vancouver B-1 and
C fractures) using a locked plate as the sole method of fracture stabilization.
Methods: A retrospective review was conducted of all Vancouver B-1
and C fractures from January 2001 through December 2005. 20 patients treated
with locked plates were identified. 15 patients had a total hip arthroplasty
and 5 had a hemiarthroplasty. There were four interprosthetic fractures
as four patients had an ipsilateral total knee arthroplasty. 17 fractures
were acute injuries and 3 were in patients referred for treatment of a nonunion.
There were 13 Vancouver B-1 and 7 Vancouver C fractures. Fracture fixation
consisted of a lateral locking implant that spanned the majority of the
femur in an attempt to maximize fixation and prevent a future peri-implant
fracture. All plates extended proximal to or within 2 cm of the lesser trochanter.
A combination of unicortical and bicortical locking and nonlocking screws
were used. Two patients who died before healing and 3 patients with less
than 12 weeks of follow-up were excluded. The remaining 15 patients formed
the study group.
Results: All patients achieved fracture union. Average follow-up
was 34.5 weeks. Average time to union was 13 weeks. There were no hardware
failures or changes in fracture alignment from operative radiographs.
Conclusion/Significance: Open reduction and internal fixation
using a locked plate that spans a majority of the femur as the sole method
of stabilization is an effective treatment method for Vancouver B-1 and
C periprosthetic femoral fractures. This method avoids the increased dissection
required for cerclage cables and allograft struts, uses conventional principles,
and should be considered as an alternative method of treatment for these
fractures.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.