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Surgical outcomes of dual-plate fixation for periprosthetic femur fractures around a stable hip arthroplasty stem

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

Abstract

Introduction

The incidence of periprosthetic femur fractures is increasing. Multiple treatment methods exist to treat fractures surrounding stable hip arthroplasty implants including locking plate fixation, cable fixation, allograft augmentation, and revision arthroplasty. No consensus regarding optimal treatment has been reached, and significant complications remain. Recently, biomechanical studies have demonstrated the benefits of orthogonal dual-plate fixation, but little clinical data exist. The purpose of the current study was to investigate the clinical and radiographic outcomes of dual-plated periprosthetic femur fractures around stable hip stems.

Materials and methods

Patients with periprosthetic femur fractures following hip arthroplasty with a stable femoral stem treated with dual-plate fixation were identified through chart review at a single institution. Fracture classification, fixation characteristics, radiographic outcomes, clinical outcomes and complications including re-operation were recorded.

Results

Over a 12-year period, 31 patients (mean age 77 years at surgery, range 48–94) underwent dual plating by three traumatologists for implant-stable periprosthetic femur fractures surrounding a hip arthroplasty stem. There were 27 Vancouver B1-type and 9 inter-prosthetic fractures. Average follow-up was 2 years. Of the 26 patients with minimum 6-month follow-up, 24 (92%) united after index surgery (mean time to union 6.0 months, range 1.5–14.0). Mean time to full weight-bearing post-operatively was 2.6 months (range 1.5–4.0 months). Two patients required secondary surgery to address nonunion.

Conclusions

Dual-plating achieved high union rates with an acceptable complication profile for the treatment of periprosthetic femur fractures surrounding a stable hip arthroplasty stem. Our preferred fixation construct involves a lateral plate spanning the entire femur secured with non-locking bicortical screws supplemented with an anteriorly based reconstruction plate. Additional prospective research is required to confirm the results of this study.

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Acknowledgements

The authors gratefully acknowledge Dr. Dean G. Lorich, who as both one of the orthopedic traumatologists who contributed cases for this study and as a mentor, educator and friend made a significant impact to his specialty. He is sorely missed by his colleagues, friends, patients and family.

Funding

The authors have no relevant financial or non-financial interests to disclose. No funding was sought or required for this research study. Institutional Review Board approval was obtained for this retrospective research.

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Authors and Affiliations

  1. Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA

    Jeremy F. Kubik, Troy D. Bornes, Craig E. Klinger & David L. Helfet

  2. Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA

    Elizabeth B. Gausden

  3. Westchester Medical Center, New York Medical College, Valhalla, NY, USA

    David S. Wellman

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  1. Jeremy F. Kubik
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Correspondence to David L. Helfet.

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This research was performed at the Hospital for Special Surgery, New York, NY.

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Kubik, J.F., Bornes, T.D., Gausden, E.B. et al. Surgical outcomes of dual-plate fixation for periprosthetic femur fractures around a stable hip arthroplasty stem. Arch Orthop Trauma Surg 142, 3605–3611 (2022). https://doi.org/10.1007/s00402-021-03950-9

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  • DOI: https://doi.org/10.1007/s00402-021-03950-9

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