Fixation of periprosthetic femoral shaft fractures adjacent to a well-fixed femoral stem with reversed distal femoral locking plate.

BACKGROUND: Numerous fixation methods have been described for the fixation of Vancouver type B1 periprosthetic fractures, but there have been a very few reports in the literature regarding the use of locking plates and their outcomes for this fracture. The objective of this study was to analyze clinically and radiographically, the results of fixation of Vancouver type B1 periprosthetic femoral fractures with a reversed distal femoral locking plate.

METHODS: Thirteen consecutive patients with Vancouver type B1 periprosthetic femoral fracture were stabilized with reversed distal femoral locking plate. Patients were followed up at 2, 6, 12, 24, and 48 weeks and yearly thereafter. They were assessed clinically and radiographically for union, delayed union, malunion, hardware failure, nonunion, infection, and stability of the femoral prosthesis.

RESULTS: The average duration of follow-up was 18 months. All fractures healed at an average of 14 weeks from fixation. Complications include superficial wound infection in one and flare-up of previous infection in one with union at 20 and 28 weeks, respectively. Twelve femoral prostheses were stable and all patients were ambulatory, with or without a walking aid at final follow-up. There was no hardware failure or nonunion.

CONCLUSIONS: Reversed distal femoral locking plate treatment is a feasible and effective choice for stabilization with femoral stem retention after Vancouver type B1 periprosthetic femoral fracture in an elderly patient population.