title: NCB-plating in the treatment of geriatric and periprosthetic femoral fractures.
abstract: BACKGROUND
  The aim of this study is the presentation of the polyaxial locking NCB-plate in the treatment of femoral fractures, especially in elderly patients and in proximity of a prosthetic implant. The reduction and fixation of these fractures is a challenging surgical procedure with high complication rates reported up to 40%.
  
  
  METHODS
  A total of 72 patients with femoral fractures had polyaxial locking plate osteosynthesis. Indications included fractures of the shaft and around an implant. Concerning surgical procedures, three different standardized techniques were performed: (1) minimally invasive with percutaneous distal insertion using a targeting device; (2) mini-open with additional cerclage wire via the same approach and (3) a conventional open reduction and internal fixation. Data collection included intraoperative data and early complications at 6, 24 and 52 weeks. Fifty-two patients had an implant or prosthesis in situ. Thirty-three patients were treated by technique (1), 32 patients had mini-open surgery and seven patients conventional open surgery.
  
  
  RESULTS
  Thirty-nine patients attended clinical follow-up after 52 weeks. Twenty-two patients were interviewed by telephone, two were untraceable and nine patients had died. Bony consolidation without secondary loss of reduction was confirmed after 52 weeks in all patients but two. Plate breakage occurred in these two at 25 and 31 weeks after surgery due to non-union. Implant related complications (17% in total) lead to surgical revision in five other cases: two deep wound infections as well as three minor revisions. When itemizing complications according to surgical technique used, most major complications occurred following open surgery.
  
  
  CONCLUSIONS
  The availability of polyaxial locking implants widened the range of indications for plate fixation in femoral fractures. The advantages of the polyaxial locking implant combined with minimally invasive surgical technique contribute to successful management of this population category. Early revision rate is noticeably lower compared to similar procedures.
  
  
  METHODS
  IV retrospective series.
authors.affiliation: Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043 Marburg, Germany. elzayat@med.uni-marburg.de
authors.forename: B F
authors.initials: BF
authors.lastname: El-Zayat
authors.forename: S
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: T
authors.initials: T
authors.lastname: Efe
authors.forename: S
authors.initials: S
authors.lastname: Fuchs-Winkelmann
authors.forename: A
authors.initials: A
authors.lastname: Krüger
authors.forename: D
authors.initials: D
authors.lastname: Kreslo
authors.forename: R
authors.initials: R
authors.lastname: Zettl
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001864:Bone Wires; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005592:Fracture Fixation / Q000295:instrumentation*; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome