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

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea

    Jae-Woo Cho, Won-Yong Shon & Jong-Keon Oh

  2. Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Min Bom Kim, Young Ho Lee & Jung Wee Park

  3. Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, 20, Ilsan-ro, Wonju, Gangwon-do, 26426, Korea

    Jinil Kim

Authors
  1. Min Bom Kim
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  2. Jae-Woo Cho
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  3. Young Ho Lee
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  4. Won-Yong Shon
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  5. Jung Wee Park
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  6. Jinil Kim
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  7. Jong-Keon Oh
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Correspondence to Jinil Kim or Jong-Keon Oh.

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The authors declare that they have no conflict of interest.

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There is no funding source.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Kim, M.B., Cho, JW., Lee, Y.H. et al. Locking attachment plate fixation around a well-fixed stem in periprosthetic femoral shaft fractures. Arch Orthop Trauma Surg 137, 1193–1200 (2017). https://doi.org/10.1007/s00402-017-2745-4

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  • DOI: https://doi.org/10.1007/s00402-017-2745-4

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