Min Bom Kim1, Jae-Woo Cho2, Young Ho Lee1, Won-Yong Shon2, Jung Wee Park1, Jinil Kim3, Jong-Keon Oh4. 1. Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea. 2. Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea. 3. Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, 20, Ilsan-ro, Wonju, Gangwon-do, 26426, Korea. huge03@gmail.com. 4. Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea. jkoh@korea.ac.kr.
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.
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.
Authors: Clemens Kösters; Daniel den Toom; Sven Märdian; Steffen Roßlenbroich; Sebastian Metzlaff; Kiriakos Daniilidis; Jens Everding Journal: J Clin Med Date: 2022-02-23 Impact factor: 4.241
Authors: Dávid Dózsai; Tamás Ecseri; István Csonka; István Gárgyán; Péter Doró; Ákos Csonka Journal: J Orthop Surg Res Date: 2020-09-15 Impact factor: 2.359