title: Cable plates and onlay allografts in periprosthetic femoral fractures after hip replacement: laboratory and clinical observations.
abstract: Fractures of the femur after total hip replacement are an increasingly common and technically challenging problem. The results of nonsurgical treatment are poor. When the general condition of the patient allows, these injuries should be treated surgically. Several surgical treatments can be used to treat these fractures, and classification of the fracture assists the surgeon in the choice of procedure. Over the past decade, cable plate fixation systems and onlay strut allografts have become two of the most commonly used methods of fixation for fractures associated with hip prostheses. The ideal method of fixation is yet to be determined. However, laboratory studies have shown that dual fixation using either a lateral plate and anterior strut graft or two strut grafts produces the strongest construct. Cables rather than smooth wires should be used for fixation, and fixation strength increases with the number of cables used. The use of screws proximally produces a strong fixation but there are theoretical disadvantages to using screws around a femoral implant. Clinical data show high rates of fracture union using cable plate fixation, cortical onlay allograft fixation, and combined fixation methods for fractures that occur around well-fixed implants. Results have been less encouraging when these techniques have been used to fix fractures around prostheses that are either loose or malaligned; such fractures are better managed by revision of the femoral component to a long-stemmed device. Care should also be taken when there has been previous periosteal stripping of the femur because this may predispose to fracture nonunion. Periprosthetic fractures of the femur are a complex surgical problem and require specialized training in a range of surgical techniques.
authors.affiliation: Division of Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Howell
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Masri
authors.forename: Donald S
authors.initials: DS
authors.lastname: Garbuz
authors.forename: Nelson V
authors.initials: NV
authors.lastname: Greidanus
authors.forename: Clive P
authors.initials: CP
authors.lastname: Duncan
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D004867:Equipment Design; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D011183:Postoperative Complications / Q000601:surgery*; D016896:Treatment Outcome