Locking attachment plate fixation around a well-fixed stem in periprosthetic femoral shaft fractures.

INTRODUCTION: Periprosthetic fractures are difficult to manage. Plating technique has been considered a reliable form of management of periprosthetic fractures with a well-fixed stem, but a dependable and stable method of plate fixation to the bone is lacking. This study reports the clinical results using a locking attachment plate (LAP) instead of cable fixation to fix locking plates to a periprosthetic femoral shaft fracture.

MATERIALS AND METHODS: Nineteen patients with periprosthetic femoral shaft fractures around well-fixed stemmed implants were studied between August 2012 and December 2014. Patients were followed up for at least 1 year postoperatively. Median age was 74 years (range 56-96 years). Fractures were classified according to the Unified Classification System, Vancouver classification, and Su classification.

PROCEDURE: Open reduction was performed under minimal incision and the locking plate was fixed to the lateral cortex of the femoral shaft. The part of the shaft without a stem was fixed to the plate using 5.0-mm locking screws, and the part with an underlying stem was fixed using 3.5-mm locking screws through the LAP instead of cables. Postoperatively, patients were managed using general principles for femoral shaft fractures.

RESULTS: Average follow-up was 16 months (range 12-36 months). All cases achieved fracture healing without loss of reduction. There were no cases of implant breakage or stem loosening at final follow-up. The average number of LAPs per fixation construct was 2.1 (range 1-4), and the average number of 3.5-mm locking screws through each LAP was 3.3 (range 2-4). The average value of plate screw density was 0.55 (range 0.37-0.8), and the average working length was four holes (range 2-8).

CONCLUSIONS: Using the LAP to manage periprosthetic fractures with a well-fixed stem could obviate the need for cable around the stem area and yield acceptable outcomes.