title: Plate failure following plate osteosynthesis in periprosthetic femoral fractures.
abstract: BACKGROUND
  Increasing numbers of total knee and hip arthroplasties result in a growing number of periprosthetic femoral fractures (PPFF). PPFF with a stable stem component are treated commonly with plate osteosynthesis. Therefore plate failure is seen as a major complication. The aim of this retrospective study was to investigate the patients' outcome after plate failure.
  
  
  METHODS
  The database of a Level 1 trauma center was searched for all patients treated for a PPFF with plate osteosynthesis. Patients with plate failure were investigated specifically. Standard demographic data, details on initial arthroplasty, trauma, and treatment were recorded for all patients. All fractures were classified and their outcome reviewed.
  
  
  RESULTS
  Seven (8.8%) out of 80 patients treated with plate osteosynthesis following PPFF met our inclusion criterion being plate failure. All these patients were female, with an average age at primary surgery of 74 ± 13 years and a mean follow-up of 885 days (range, 264-2549). Four patients suffered a PPFF after total hip arthroplasty (THA) (2 Vancouver Type B1 and 2 Type C) and three after total knee arthroplasty (TKA) (Lewis-Rorabeck Type II). Following plate failure, four patients healed uneventfully and three patients experienced complications such as pseudarthrosis, screw loosening, and further plate failure.
  
  
  CONCLUSIONS
  In patients with poor bone quality, bone graft, bone cement, and bone biologics have to be considered in revision surgery. Furthermore, long-stem revision and tumor prosthesis are an additional solution.
authors.affiliation: Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. sandra.boesmueller@meduniwien.ac.at.
authors.forename: Sandra
authors.initials: S
authors.lastname: Boesmueller
authors.affiliation: Department of Trauma Surgery-Campus Innenstadt, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Sebastian F
authors.initials: SF
authors.lastname: Baumbach
authors.affiliation: Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Marcus
authors.initials: M
authors.lastname: Hofbauer
authors.affiliation: Department for Trauma, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Gerald E
authors.initials: GE
authors.lastname: Wozasek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D001317:Austria / Q000453:epidemiology; D001860:Bone Plates / Q000706:statistics & numerical data*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000453:epidemiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011475:Prosthesis Failure; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Complications; Periprosthetic femoral fracture; Plate failure