Reversed Contralateral LISS Plate for Vancouver B1 Periprosthetic Femoral Shaft Fractures

Abstract

The authors reviewed all patients treated for periprosthetic femur fractures between March 1, 2007, and January 31, 2010 at the senior author's institution. Demographic features, mechanism of injury, radiographs, and computed tomography scans were reviewed to determine the type and stability of the femoral implant at the time of injury. All Vancouver B1 fractures were treated with a novel technique that used a contoured distal femoral locking plate intended for the contralateral femur and reversed to accommodate the ipsilateral femoral bow and contour of the proximal femur. Fixation was achieved around the implant with percutaneously placed unicortical and/or bicortical screws. Radiographs were reviewed for fracture healing, malunion, implant failure, and prosthetic loosening. Fifteen patients were identified and underwent the procedure as described. One patient died soon after surgery of complications from a ruptured preexisting esophageal ulcer. Of the remaining 14 patients, the average duration of follow-up was 25 months (range, 6-31 months). Two patients did not achieve union; however, repeat interpretation of the presenting radiographs showed likely misdiagnosed Vancouver B2 fractures. The first patient had late aseptic loosening and underwent revision surgery 22 weeks postoperatively. The other had early loss of fixation that required revision with a long stem prosthesis. Other complications included 1 deep venous thrombosis and 2 superficial wound infections. The infections were successfully treated with a single formal irrigation and debridement, primary closure, and a short course of oral antibiotics. Ultimately, in 86% of patients (12/14), fracture healing occurred with this biologically friendly technique.

Use of a cerclage cable‐plate system to stabilize a periprosthetic femoral fracture after total hip replacement in a dog

“…Successful clinical use of cable‐plate systems has also been reported in man for the treatment of type B1 PPF, which is a common complication in geriatric populations with poor bone quality . Contraindications to using cable‐plate constructs alone include loose or malaligned prostheses, in which arthroplasty revision is preferred, as well as previous periosteal stripping or devascularization because compression from the cables may theoretically further delay bony union …”

Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis

“…Among 39 studies, 10 articles compared the results of Vancouver B1 PFFs treated with ORIF with that of B2 PFFs, and were included in a pair-wise meta-analysis 4 6 7 8 9 16 17 18 21 22) . Twenty-five single cohort studies 1 2 5 20 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43) reported outcomes after surgery for treatment of Vancouver B1 PFFs, and four single cohort studies with Vancouver B2 44 45 46 47) . The studies identified for the meta-analysis included 1,348 femurs: 917 Vancouver B1 PFFs, and 431 Vancouver B2 PFFs ( Table 1 ).…”

Finite element analysis of double-plate fixation using reversed locking compression-distal femoral plates for Vancouver B1 periprosthetic femoral fractures

“…An alternative approach of using a reversed contralateral distal femoral locking plating has been reported for the treatment of Vancouver B1 fractures, with a good fracture union rate. However, there is always a risk of failure due to plate weight-bearing [19][20][21]. Addition of an anterior locked plate to the reversed contralateral locking compression-distal femoral plates (LCP-DF) might be a good choice to improve fixation stability and overcome the weight-bearing restriction when using a single-plate system.…”