Original Article
Less Invasive Stabilization System for the Management of Periprosthetic Femoral Fractures Around Hip Arthroplasty

https://doi.org/10.1016/j.arth.2007.01.028Get rights and content

Abstract

We present a study of 18 periprosthetic femoral fractures treated with less invasive stabilization system between September 2001 and March 2005. Three patients died during the follow-up period owing to unrelated causes and are excluded from the final results. The average age was 81.6 years, and the average follow-up period was 11.7 months. Twelve patients had significant comorbidities preoperatively. The surviving 15 patients had satisfactory fracture union, although one patient required replating with a less invasive stabilization system plate after a fall. One patient developed deep infection with a chronic sinus. Three patients were noted to have mild to moderate discomfort around the prominent implant.

Section snippets

Patients and Methods

Eighteen patients with a periprosthetic femoral fracture were treated with titanium LISS plates between September 2001 and March 2005. There were 2 male and 16 female patients. The average age at the time of injury was 81.6 years (range, 63-93years). Twelve of the patients had significant comorbidities. One patient had also sustained an ipsilateral ankle fracture. The fractures were classified according to the Vancouver classification for periprosthetic fracture of femur [7]. Our indications

Fracture Union

Fracture union was achieved in all 15 patients with an average union time of 18.6 weeks (12-28weeks) (Fig. 1, Fig. 2, Fig. 3). One patient had a fall 17days postoperatively, which required a further LISS plate fixation. This fracture united 24 weeks after the second operation. All fractures healed in satisfactory alignment in both coronal and sagittal planes. There was no loss of reduction despite early partial weight bearing, and we believe that it may actually encourage fracture union.

Hospital Stay and Discharge

The

Discussion

The aim of the management of periprosthetic fractures of the femur is fracture union with early mobilization and a rapid return to the prefracture state. There are various methods described for the management of this injury. Frigg et al [8] in their anatomical study of LISS plates found that unicortical purchase was sufficient to ensure the stability of the fracture. This is particularly useful in the management of periprosthetic fractures where the femoral stem obstructs the access to the

References (10)

  • M.G. Dennis et al.

    Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem. A biomechanical study of 5techniques

    J Arthroplasty

    (2000)
  • I.D. Learmonth

    The management of periprosthetic fractures around the femoral stem

    J Bone Joint Surg Br

    (2004)
  • J. Borrelli et al.

    Extra osseousblood supply of the tibia and the effects of different plating techniques: a human cadaver study

    J Orthop Trauma

    (2002)
  • A. Marti et al.

    Biomechanical evaluation of the less invasive stabilization system for the internal fixation of distal femur fractures

    J Orthop Trauma

    (2001)
  • M.R. Bon et al.

    Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty

    J Arthroplasty

    (2002)
There are more references available in the full text version of this article.

Cited by (23)

  • Radiologic outcomes of open reduction and internal fixation for cementless stems in Vancouver B2 periprosthetic fractures

    2019, Acta Orthopaedica et Traumatologica Turcica
    Citation Excerpt :

    In this study, which used ORIF to treat Vancouver type B2 PFF, rather than revision arthroplasty, minimized perioperative complications. Several authors have reported that fixation of PFF using plates is a reliable treatment option associated with a low rate of complications.13,30,31 Niikura et al treated select Vancouver type B2 patients with ORIF, achieved reliable outcomes, and suggested that decisions regarding the treatment of PFF should take into account not only the algorithmic approach of the Vancouver system but also on an assessment of each patient's physical status and activity level.12

  • Minimally invasive plate osteosynthesis with locking compression plate in patients with Vancouver type B1 periprosthetic femoral fractures

    2018, Injury
    Citation Excerpt :

    LCP has been used as a surgical tool for treating Vancouver type B1 fractures, and its advantages appear to be improved axial loading and torsional strength compared with conventional plates, high angular stability, stable fixation despite use of unicortical screws even in the femur with osteoporotic bone quality [13,15,21,25–29]. Despite these biomechanical advantages, several previous studies have reported complications (e.g., relatively high metal failure rate, infection, non-union) [12,21,30,31]. These complications can be caused by poor surgical skills of an operator (e.g., inadequate fracture reduction and excessively firm fixation of bone fragments by using too many screws) [30,32], soft tissue injury and periosteal dissection in the process of anatomical reduction and plate fixation and decreased periosteal blood supply due to internal fixatives [33].

  • Periprosthetic femoral fractures treated by locked plating: Feasibility assessment of the mini-invasive surgical option. A prospective series of 36 fractures

    2011, Orthopaedics and Traumatology: Surgery and Research
    Citation Excerpt :

    The most relevant element was the possibility of rapid recovery of walking, which was confirmed by the absence of complications related to the decubitus position and the very low rate of general morbidity reported in this series. There are an increasing number of series describing the treatment of periprosthetic fractures with a locking plate system [7–10,12,14–17,21–24]. Certain report mechanical failures due to material defects: three broken screws in 59 cases (5%) [7], 2/16 cases (12.5%) of plate breakage [8], three broken plates and three cases of plate pull out and loss of fixation out of 14 cases (43%) [12], 1/12 cases (8.5%) of loss off fixation and plate pull out [21], 1/24 cases (4%) of loss of fixation and plate pull out [23].

View all citing articles on Scopus

No benefits or funds were received in support of the study.

View full text