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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 11, 1424-1430.
doi: 10.1302/0301-620X.91B11.22292  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component

K. Corten, MD, Orthopaedic Surgeon1; F. Vanrykel, MD, Resident2; J. Bellemans, MD, PhD, Head of the Orthopaedic Department1; P. Reynders Frederix, MD, PhD, Orthopaedic Surgeon2; J.-P. Simon, MD, PhD, Orthopaedic Surgeon1; and P. L. O. Broos, MD, PhD, Head of Department of Traumatology2

1 University Hospitals Leuven (Pellenberg), Weligerveld 1, 3212 Pellenberg, Belgium.
2 Department of Traumatology University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.

Correspondence should be sent to Dr K. Corten; e-mail: kristoff.corten{at}uz.kuleuven.ac.be

The use of plate-and-cable constructs to treat periprosthetic fractures around a well-fixed femoral component in total hip replacements has been reported to have high rates of failure. Our aim was to evaluate the results of a surgical treatment algorithm to use these lateral constructs reliably in Vancouver type-B1 and type-C fractures. The joint was dislocated and the stability of the femoral component was meticulously evaluated in 45 type-B1 fractures. This led to the identification of nine (20%) unstable components. The fracture was considered to be suitable for single plate-and-cable fixation by a direct reduction technique if the integrity of the medial cortex could be restored.

Union was achieved in 29 of 30 fractures (97%) at a mean of 6.4 months (3 to 30) in 29 type-B1 and five type-C fractures. Three patients developed an infection and one construct failed.

Using this algorithm plate-and-cable constructs can be used safely, but indirect reduction with minimal soft-tissue damage could lead to shorter times to union and lower rates of complications.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General