title: Superior outcome of strut allograft-augmented plate fixation for the treatment of periprosthetic fractures around a stable femoral stem.
abstract: OBJECTIVE
  This study was designed to compare the outcome of two surgical approaches for treating femoral periprosthetic fractures around a stable femoral stem. The hypothesis was that plate fixation alone might be associated with a higher complication rate due to insufficient mechanical stability. We also considered that the addition of a strut allograft would contribute to fracture healing by means of osteoconduction.
  
  
  METHODS
  We retrospectively assessed the outcome of 21 patients who sustained periprosthetic fractures around a total hip replacement system (Vancouver type B1 and type C fractures) and who were treated in our department (January 2006 and August 2011) either by plate fixation alone or by plate fixation and a strut allograft. The mean postoperative follow-up was 23 months (range 9-69 months). Eleven patients were treated by plate fixation alone (Plate Group), and 10 patients were treated by plate fixation and a deep frozen cortical strut allograft (AG Group). Functional outcome was rated by the Harris Hip scoring system. Postoperative radiographs were assessed for evidence of fracture union. Surgical failure was defined as any complication requiring surgical revision.
  
  
  RESULTS
  The 21 patients included 17 females and 4 males. The average age was 79 years (range, 73-88) for the Plate Group and 82 years (range, 53-94) for the AG Group, and the average time to fracture union was 12 weeks (range, 2.5-6 months) and 12.95 weeks (range, 1.5-3) respectively. The overall failure rate was significantly higher in the Plate Group: 5 of them required revision surgery compared to none in the AG Group (p=0.014).
  
  
  CONCLUSIONS
  The results of this analysis indicate that a strut allograft augmentation approach to Vancouver type B1 and type C periprosthetic fractures results in a better outcome than plate fixation alone by apparently adding mechanical stability and enhancing the biological healing process.
authors.affiliation: Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: Morsi.kh@gmail.com.
authors.forename: Morsi
authors.initials: M
authors.lastname: Khashan
authors.forename: Eyal
authors.initials: E
authors.lastname: Amar
authors.forename: Michael
authors.initials: M
authors.lastname: Drexler
authors.forename: Ofir
authors.initials: O
authors.lastname: Chechik
authors.forename: Zvi
authors.initials: Z
authors.lastname: Cohen
authors.forename: Ely L
authors.initials: EL
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D019644:Arthroplasty, Replacement, Hip; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D006801:Humans; D008297:Male; D057068:Periprosthetic Fractures / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Femur; Fracture; Periprosthetic; Plate; Stem; Strut allograft; THR; Union