RESULTS OF DALL MILES CABLE PLATE FIXATION FOR PERIPROSTHETIC FRACTURES OF FEMUR: ARE TWO PLATES BETTER THAN ONE

Abstract

Introduction: With an aging population, the number of hemiarthroplasties and Total Hip Replacements is on a rise. Though uncommon, one of the serious postoperative complications is periprosthetic fracture of femur. Dall Miles cable plate system is widely used for fixation of these fractures.

Patient and Methods: We present a series of of 19 patients who underwent Dall Miles cable plate fixation for periprosthetic fracture over a hemiarthroplasty or a total hip replacement during the last 5 years, reporting clinical and radiological outcome measures.

Results: Female to male ratio was 2:1. The average age was 77.33 (range from 55 to 93). Eight patients had the periprosthetic fracture after hemiarthroplasty while 11 had it after Total Hip Replacement. These two group were completely different in terms of their fitness, activities and expectations. Twelve were Vancouver B 1, 7 were Vancouver C. Five were initially managed with two plates, the remainder had one plate only.

Patients were followed up at an average of 3.1 years (range 3.2 months to 5.1 years). Three patients had died at the time of our follow up due to unrelated medical problems. One patient had deep infection that required revision and 1 had superficial infection that healed with antibiotics. 1 patient underwent revision to a THR for hip pain.

Of those managed with a single plate, 3 patients had plate/cable failure and underwent revision DM plating with 2 plates and cables along with allogenic bone grafting; all of these healed well. All of these patients had periprosthetic # following a THR.

Five patients managed initially with 2 DM plates healed without any complications.

Discussion: Even in this small series, we feel it is evident that Dall Miles plating using a single plate has a high incidence of plate failure (3 of 13). Orthogonal plating has been widely used in past for fixation of complex fractures and nonunions. We feel there is a distinct advantage of using two plates of uneven lengths to improve chances of healing, preventing implant failure and reducing stress riser effect. We advocate primary fixation of periprosthetic fractures of proximal femur over THR using 2 Dall Miles cable plates and bone graft. We would like to present our results and discuss this complex topic further.