Abstract
Background
The optimal technique for plate fixation to treat type B and C periprosthetic femoral fractures (PFFs) is unclear. The purpose of this study is to evaluate the radiographic results of inner-side-out limited contact dynamic compression plate (LC-DCP) to treat PFFs during or after total hip arthroplasty (THA).
Methods
This retrospective study comprised of four men and six women with an average age of 64.7 years who underwent open reduction and internal fixation with an inner-side-out LC-DCP technique to treat PFFs; the reduction was maintained preliminary with the use of contoured plate and cables, and the grooves on the undersurface of LC-DCP for limited contact was used to hold and prevent the cables from slippage during tightening the cables. There were five intraoperative and five postoperative PFFs after THA. According to the Vancouver classification, the intraoperative PFFs included type B2 in two, B3 in one and C3 in two patients while postoperative PFFs were categorized into type B1 in one, type B2 in two and type C in two patients. The mean follow-up duration was 5.9 years (range 1–10.4). We evaluated radiographic union and complications after index operation.
Results
All patients demonstrated radiographic bone union at an average follow-up duration of 4.4 months (range 3–8). Two patients showed stem subsidence after revision THA and one patient demonstrated a subsequent peri-implant fracture around the distal end of plate after union of the initial PPF; one patient underwent re-revision THA for stem loosening while another patient went through refixation for the peri-implant fracture. There was no nonunion, infection, nerve injury, or dislocation.
Conclusion
The inner-side-out LC-DCP technique showed satisfactory radiographic outcome. In certain situations where locking plates are not available, this technique might be a useful alternative for treating type B and C PFFs.
This is a preview of subscription content, log in via an institution to check access.
available at the time, it was refixed with a antomical pre-shaped locking plate using less invasive plate-osteosynthesis technique. At the final follow-up, bone union was shown on the anteroposterior view of right femur (d)
Similar content being viewed by others
References
Park, S. K., Kim, Y. G., & Kim, S. Y. (2011). Treatment of periprosthetic femoral fractures in hip arthroplasty. Clinics in Orthopedic Surgery., 3, 101–106.
Abdel, M. P., Watts, C. D., Houdek, M. T., Lewallen, D. G., & Berry, D. J. (2016). Epidemiology of periprosthetic fracture of the femur in 32,644 primary total hip arthroplasties: A 40-year experience. The Bone and Joint Journal., 98, 461–467.
Moloney, G. B., Westrick, E. R., Siska, P. A., & Tarkin, I. S. (2014). Treatment of periprosthetic femur fractures around a well-fixed hip arthroplasty implant: Span the whole bone. Archives of Orthopaedic and Trauma Surgery., 134, 9–14.
Kim, M. W., Chung, Y. Y., Lee, J. H., & Park, J. H. (2015). Outcomes of surgical treatment of periprosthetic femoral fractures in cementless hip arthroplasty. Hip & Pelvis., 27, 146–151.
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, 725–733.
Lee, J. M., Kim, T. S., & Kim, T. H. (2018). Treatment of periprosthetic femoral fractures following hip arthroplasty. Hip & pelvis., 30, 78–85.
Chakrabarti, D., Thokur, N., & Ajnin, S. (2019). Cable plate fixation for Vancouver Type-B1 periprosthetic femoral fractures—Our experience and identification of a subset at risk of non-union. Injury, 50, 2301–2305.
Lever, J. P., Zdero, R., Nousiainen, M. T., Waddell, J. P., & Schemitsch, E. H. (2010). The biomechanical analysis of three plating fixation systems for periprosthetic femoral fracture near the tip of a total hip arthroplasty. Journal of Orthopaedic Surgery and Research., 5, 45.
Yang, X. J., Fei, J., Wang, Z. G., Yu, H. J., & Sun, J. (2005). Experimental study and clinical observation of minimum-contact plate in long bone fracture. Chinese Journal of Traumatology., 8, 105–110.
Perren, S. M., Klaue, K., Pohler, O., Predieri, M., Steinemann, S., & Gautier, E. (1990). The limited contact dynamic compression plate (LC-DCP). Archives of Orthopaedic and Trauma Surgery., 109, 304–310.
Brady, O. H., Kerry, R., Masri, B. A., Garbuz, D. S., & Duncan, C. P. (1999). The vancouver classification of periprosthetic fractures of the Hip: A rational approach to treatment. Techniques in Orthopaedics., 14, 107–114.
Moore, R. E., Baldwin, K., Austin, M. S., & Mehta, S. (2014). A systematic review of open reduction and internal fixation of periprosthetic femur fractures with or without allograft strut, cerclage, and locked plates. Journal of Arthroplasty, 29, 872–876.
Bottlang, M., Schemitsch, C. E., Nauth, A., et al. (2015). Biomechanical concepts for fracture fixation. Journal of Orthopaedic Trauma., 29(Suppl 12), S28–33.
Tsiridis, E., Narvani, A. A., Timperley, J. A., & Gie, G. A. (2005). Dynamic compression plates for Vancouver type B periprosthetic femoral fractures: a 3-year follow-up of 18 cases. Acta Orthopaedica, 76, 531–537.
Strom, A. M., Garcia, T. C., Jandrey, K., Huber, M. L., & Stover, S. M. (2010). In vitro mechanical comparison of 2.0 and 2.4 limited-contact dynamic compression plates and 2.0 dynamic compression plates of different thicknesses. Veterinary Surgery., 39, 824–828.
Knutsen, A. R., Lau, N., Longjohn, D. B., Ebramzadeh, E., & Sangiorgio, S. N. (2017). Periprosthetic femoral bone loss in total hip arthroplasty: systematic analysis of the effect of stem design. Hip International, 27, 26–34.
Randelli, F., Pace, F., Priano, D., Giai Via, A., & Randelli, P. (2018). Re-fractures after periprosthetic femoral fracture: A difficult to treat growing evidence. Injury, 49(Suppl 3), S43–S47.
Kinov, P., Volpin, G., Sevi, R., Tanchev, P. P., Antonov, B., & Hakim, G. (2015). Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: Our institutional experience. Injury, 46, 1945–1950.
Min, B. W., Cho, C. H., Son, E. S., Lee, K. J., Lee, S. W., & Min, K. K. (2018). Minimally invasive plate osteosynthesis with locking compression plate in patients with Vancouver type B1 periprosthetic femoral fractures. Injury, 49, 1336–1340.
Froberg, L., Troelsen, A., & Brix, M. (2012). Periprosthetic Vancouver type B1 and C fractures treated by locking-plate osteosynthesis: Fracture union and reoperations in 60 consecutive fractures. Acta Orthopaedica, 83, 648–652.
Taylor, B. C., Triplet, J. J., & El-Sabawi, T. (2019). Off-label use in orthopaedic surgery. The Journal of the American Academy of Orthopaedic Surgeons., 27, e767–e774.
Augat, P., & von Rüden, C. (2018). Evolution of fracture treatment with bone plates. Injury, 49, S2–S7.
Ahern, B. J., Showalter, B. L., Elliott, D. M., Richardson, D. W., & Getman, L. M. (2013). In vitro biomechanical comparison of a 4.5 mm narrow locking compression plate construct versus a 4.s5 mm limited contact dynamic compression plate construct for arthrodesis of the equine proximal interphalangeal joint. Veterinary Surgery., 42, 335–339.
Snow, M., Thompson, G., & Turner, P. G. (2008). A mechanical comparison of the locking compression plate (LCP) and the low contact-dynamic compression plate (DCP) in an osteoporotic bone model. Journal of Orthopaedic Trauma., 22, 121–125.
Gardner, M. J., Brophy, R. H., Campbell, D., et al. (2005). The mechanical behavior of locking compression plates compared with dynamic compression plates in a cadaver radius model. Journal of Orthopaedic Trauma., 19, 597–603.
Wood, G. C., Naudie, D. R., McAuley, J., & McCalden, R. W. (2011). Locking compression plates for the treatment of periprosthetic femoral fractures around well-fixed total hip and knee implants. Journal of Arthroplasty, 26, 886–892.
Singh, A. K., Narsaria, N., Seth, R. R., & Garg, S. (2014). Plate osteosynthesis of fractures of the shaft of the humerus: Comparison of limited contact dynamic compression plates and locking compression plates. Journal of Orthopaedics and Traumatology., 15, 117–122.
Saikia, K., Bhuyan, S., Bhattacharya, T., Borgohain, M., Jitesh, P., & Ahmed, F. (2011). Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate. Indian Journal of Orthopaedics., 45, 417–421.
Molinari, G. P., Giaffreda, G., Clementi, D., Cabbanè, G., Galmarini, V., & Capelli, R. M. (2020). Surgical treatment of peri-prosthetic femur fractures with dedicated NCB plates: our experience. Acta Bio-Medica: Atenei Parmensis., 91, 297–304.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by HW, J-YK, S-HB, WH, J-WY, and S-YK. The first draft of the manuscript was written by HW, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical standard statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent
Informed consent for study inclusion was obtained from all patients.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Won, H., Kim, JY., Baek, SH. et al. Feasibility of the Inner-Side-Out Use of the LC-DCP for Periprosthetic Femoral Fracture in Total Hip Arthroplasty. JOIO 54, 879–884 (2020). https://doi.org/10.1007/s43465-020-00200-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-020-00200-9