Surgical Outcomes of Dual-Plate Fixation for Periprosthetic Femur Fractures Around a Stable Hip Arthroplasty Stem

Authors

Jeremy F. Kubik, Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
Troy D. Bornes, Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
Elizabeth B. Gausden, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
Craig E. Klinger, Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
David S. Wellman, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
David L. Helfet, Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA. helfetd@hss.edu.

Author Type(s)

Faculty

DOI

10.1007/s00402-021-03950-9

Journal Title

Archives of Orthopaedic and Trauma Surgery

First Page

3605

Last Page

3611

Document Type

Article

Publication Date

12-1-2022

Department

Orthopedic Surgery

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.

Recommended Citation

Kubik, J. F., Bornes, T. D., Gausden, E. B., Klinger, C. E., Wellman, D. S., & Helfet, D. L. (2022). Surgical Outcomes of Dual-Plate Fixation for Periprosthetic Femur Fractures Around a Stable Hip Arthroplasty Stem. Archives of Orthopaedic and Trauma Surgery, 142 (12), 3605-3611. https://doi.org/10.1007/s00402-021-03950-9