Nail and Locking Plate for Periprosthetic Fractures

Abstract

The incidence of periprosthetic fractures have been increasing, and in patients with osteopenic bone, high body mass index, or a combination both, they are difficult to treat and pose a high risk for malunion. Previous studies have compared the use of locking plates and intramedullary nails, and have found that each has its own strengthens and drawbacks, but neither is superior in terms of treating periprosthetic fractures. Here, we present the technique and series of patients treated with a combination of a retrograde intramedullary nail and flare-to-flare lateral locking plate without the use of allograft or autograft supplementation.

Double fixation for complex distal femoral fractures

“…Several case series have used the nail-and-plate construct in different clinical situations and reported overall high union rates (42,45,46,47,48). Liporace and Yoon (42) used the nail-and-plate construct for primary fracture fixation X-rays of the injury.…”

Nail–Plate Constructs for Periprosthetic Distal Femur Fractures

“…Liporace and Yoon prefer the nail to end between the calcar and the lesser trochanter to allow prophylactic screws from the plate to be placed into the femoral neck, 10 while Kanabur et al used a shorter 200 mm nail. 12 Please refer ►Figs. 1 and 2 for case example.…”

“…11 While other studies used the NPC for the successful treatment of nonunions in native knees, Kanabur et al published a technique guide and case series of eight obese patients with periprosthetic distal femur fractures treated with NPC and radiographic osteoporosis. 12 Patients in their cohort were also obese, with body mass indices averaging 29. In their series, fractures were reduced, stabilized with a retrograde intramedullary nail, and then a supplemental lateral plate placed.…”

“…All patients went on to successfully heal. 12 Liporace and Yoon also published their experience using the NPC for primary fracture fixation in a case series of both native and periprosthetic fractures. 10 Over the last 3 years, these authors have published multiple studies using adjunct plates to supplement intramedullary nails in the tibia.…”

Intramedullary Nail and Plate Combination Technique for Peri-Implant Both-Bone Forearm Fractures

“…In geriatric distal femur fractures, a combination nail and plate technique has been demonstrated to be effective in allowing early weight-bearing and providing quality range of motion [ 11 ]. The IMN and plate fixation technique has also been shown to be effective in treating peri-implant fractures of the femur as it provides protection and stability of the bone while allowing full weight-bearing [ 12 , 13 ]. However, there is a paucity of data supporting the use of this technique for diaphyseal both-bone forearm fractures.…”