Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 1, pp 9–14 | Cite as

Treatment of periprosthetic femur fractures around a well-fixed hip arthroplasty implant: span the whole bone

  • Gele B. Moloney
  • Edward R. Westrick
  • Peter A. Siska
  • Ivan S. TarkinEmail author
Orthopaedic Surgery



Periprosthetic femur fractures are a growing problem in the geriatric population. This study examines Vancouver B1 periprosthetic femur fractures treated with open reduction internal fixation using a laterally based plate. Outcomes using plates which spanned the length of the femur to the level of the femoral condyles were compared to those which did not. The hypothesis was that spanning internal fixation would result in a decreased rate of refracture and subsequent reoperation.

Materials and methods

Patients admitted to three affiliated academic hospitals treated with open reduction internal fixation for a periprosthetic femur fracture in the setting of a preexisting total hip arthroplasty or hemiarthroplasty stem were identified. Patient data were reviewed for age, gender, fracture classification, operative intervention, time to union, as well as complications related to treatment and need for further surgery.


Over a 5-year period, 58 patients were treated with open reduction internal fixation using a laterally based plate for Vancouver B1 femur fractures. Twenty-one patients were treated with plates that extended to the level of the femoral condyles. In that group there were no nonunions or subsequent periprosthetic fractures reported. Of 36 patients treated with short plates, 3 went on to nonunion resulting in plate failure and refracture and 2 sustained a subsequent fracture distal to the existing fixation.


In this series, fixation for periprosthetic femur fractures around a well-fixed arthroplasty stem which spans the length of the femur to the level of the femoral condyles is associated with a decreased rate of nonunion and refracture. By decreasing the rate of refracture and nonunion, spanning fixation decreases the morbidity and mortality associated with additional surgery in a fragile geriatric population.


Geriatric hip fracture Periprosthetic femur fracture 


Conflict of interest



  1. 1.
    Kurtz S (2007) Projection of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg 89(4):780–785CrossRefGoogle Scholar
  2. 2.
    Lewallen DG, Berry DJ (1998) Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect 47:243–249PubMedGoogle Scholar
  3. 3.
    Kavanagh BF (1992) Femoral fractures associated with total hip arthroplasty. Orthop Clin N Am 23(2):249–257Google Scholar
  4. 4.
    Berry DJ (1999) Epidemiology: hip and knee. Orthop Clin N Am 30(2):183–190CrossRefGoogle Scholar
  5. 5.
    Ricci WM, Haidukewych GJ (2010) Periprosthetic fractures, in rockwood and green’s fractures in adults. In: Heckman JD, Bucholz RW, Court-Brown CM, Tornetta P (eds) Lippincott Williams & Wilkins, 7ed. p 555–589Google Scholar
  6. 6.
    Xue H et al (2011) Locking compression plate and cerclage band for type B1 periprosthetic femoral fractures preliminary results at average 30-month follow-up. J Arthroplasty. 26(3):467–471 e1Google Scholar
  7. 7.
    Ricci WM et al (2005) Indirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant. J Bone Jt Surg Am 87(10):2240–2245CrossRefGoogle Scholar
  8. 8.
    Fulkerson E et al (2006) Fixation of periprosthetic femoral shaft fractures associated with cemented femoral stems: a biomechanical comparison of locked plating and conventional cable plates. J Orthop Trauma 20(2):89–93PubMedCrossRefGoogle Scholar
  9. 9.
    Beals RK, Tower SS (1996) Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res (327):238–46Google Scholar
  10. 10.
    Bhattacharyya T, Chang D, Meigs JB, Estok DM, Malchau H (2007) Mortality after periprosthetic fracture of the femur. J Bone Jt Surg Am 89:2658–2652Google Scholar
  11. 11.
    Lindahl H, Malchau H, Oden A, Garellick G (2006) Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Jt Surg Br 88B:26–30Google Scholar
  12. 12.
    Wood GC et al (2010) Locking compression plates for the treatment of periprosthetic femoral fractures around well-fixed total hip and knee implants. J Arthroplast 26(6):886–892Google Scholar
  13. 13.
    Chakravarthy J, Bansal R, Cooper J (2007) Locking plate osteosynthesis for Vancouver Type B1 and Type C periprosthetic fractures of femur: a report on 12 patients. Injury 38(6):725–733PubMedCrossRefGoogle Scholar
  14. 14.
    Bryant GK, Morshed S, Agel J, Henley MB, Barei DP, Taitsman LA, Nork SE (2009) Isolated locked compression plating for Vancouver type B1 periprosthetic femoral fractures. Injury 40:1180–1186Google Scholar
  15. 15.
    Buttaro MA et al (2007) Locking compression plate fixation of Vancouver type-B1 periprosthetic femoral fractures. J Bone Jt Surg Am 89(9):1964–1969CrossRefGoogle Scholar
  16. 16.
    Uzoigwe CE, Burnand HG, Cheesman CL, Aghedo DO, Faizi M, Middleton RG (2012) Early and ultra-early surgery in hip fracture patients improves survival. Injury 44(6):726–729Google Scholar
  17. 17.
    Kammerlander C, Gosch M, Kammerlander-Knauer U, Luger TJ, Blauth M, Roth T (2011) Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 131(10):1435–1444PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Gele B. Moloney
    • 1
  • Edward R. Westrick
    • 1
  • Peter A. Siska
    • 1
  • Ivan S. Tarkin
    • 1
    Email author
  1. 1.Division of Orthopaedic Trauma, Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA

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