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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 9/2017

01-09-2017 | Orthopaedic Surgery

Locking attachment plate fixation around a well-fixed stem in periprosthetic femoral shaft fractures

Authors: Min Bom Kim, Jae-Woo Cho, Young Ho Lee, Won-Yong Shon, Jung Wee Park, Jinil Kim, Jong-Keon Oh

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2017

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Abstract

Introduction

Periprosthetic fractures are difficult to manage. Plating technique has been considered a reliable form of management of periprosthetic fractures with a well-fixed stem, but a dependable and stable method of plate fixation to the bone is lacking. This study reports the clinical results using a locking attachment plate (LAP) instead of cable fixation to fix locking plates to a periprosthetic femoral shaft fracture.

Materials and methods

Nineteen patients with periprosthetic femoral shaft fractures around well-fixed stemmed implants were studied between August 2012 and December 2014. Patients were followed up for at least 1 year postoperatively. Median age was 74 years (range 56–96 years). Fractures were classified according to the Unified Classification System, Vancouver classification, and Su classification.

Procedure

Open reduction was performed under minimal incision and the locking plate was fixed to the lateral cortex of the femoral shaft. The part of the shaft without a stem was fixed to the plate using 5.0-mm locking screws, and the part with an underlying stem was fixed using 3.5-mm locking screws through the LAP instead of cables. Postoperatively, patients were managed using general principles for femoral shaft fractures.

Results

Average follow-up was 16 months (range 12–36 months). All cases achieved fracture healing without loss of reduction. There were no cases of implant breakage or stem loosening at final follow-up. The average number of LAPs per fixation construct was 2.1 (range 1–4), and the average number of 3.5-mm locking screws through each LAP was 3.3 (range 2–4). The average value of plate screw density was 0.55 (range 0.37–0.8), and the average working length was four holes (range 2–8).

Conclusions

Using the LAP to manage periprosthetic fractures with a well-fixed stem could obviate the need for cable around the stem area and yield acceptable outcomes.
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Metadata
Title
Locking attachment plate fixation around a well-fixed stem in periprosthetic femoral shaft fractures
Authors
Min Bom Kim
Jae-Woo Cho
Young Ho Lee
Won-Yong Shon
Jung Wee Park
Jinil Kim
Jong-Keon Oh
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 9/2017
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-017-2745-4

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