title: An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component.
abstract: The use of plate-and-cable constructs to treat periprosthetic fractures around a well-fixed femoral component in total hip replacements has been reported to have high rates of failure. Our aim was to evaluate the results of a surgical treatment algorithm to use these lateral constructs reliably in Vancouver type-B1 and type-C fractures. The joint was dislocated and the stability of the femoral component was meticulously evaluated in 45 type-B1 fractures. This led to the identification of nine (20%) unstable components. The fracture was considered to be suitable for single plate-and-cable fixation by a direct reduction technique if the integrity of the medial cortex could be restored. Union was achieved in 29 of 30 fractures (97%) at a mean of 6.4 months (3 to 30) in 29 type-B1 and five type-C fractures. Three patients developed an infection and one construct failed. Using this algorithm plate-and-cable constructs can be used safely, but indirect reduction with minimal soft-tissue damage could lead to shorter times to union and lower rates of complications.
authors.affiliation: University Hospitals Leuven (Pellenberg), Weligerveld 1, 3212 Pellenberg, Belgium. kristoff.corten@uz.kuleuven.ac.be
authors.forename: K
authors.initials: K
authors.lastname: Corten
authors.forename: F
authors.initials: F
authors.lastname: Vanrykel
authors.forename: J
authors.initials: J
authors.lastname: Bellemans
authors.forename: P Reynders
authors.initials: PR
authors.lastname: Frederix
authors.forename: J-P
authors.initials: JP
authors.lastname: Simon
authors.forename: P L O
authors.initials: PL
authors.lastname: Broos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing; D006621:Hip Joint / Q000503:physiopathology; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome