245. TREATMENT OF PERIPROSTHETIC FRACTURES OF THE FEMUR BY IMPLANTS WITH MULTIDIRECTIONAL LOCKING SCREWS

Abstract

Purpose of the study: Implants with multidirectional locking screws theoretically have many advantages for the treatment of periprosthetic fractures. In the event of osteoporotic bone, this system of plate fixation ensures stability and better bone fixation. Using screws anchored in the different angles, we proposed rigid fixation around the prosthesis. We conducted a retrospective analysis of outcomes obtained after treatment of perprosthetic femoral fractures, Vancouver B1 and C, comparing two types of implants with angular stability (straight plate and folded plate).

Material and methods: From June 1999 to December 2007, we treated 58 patients with periprothetic fractures of the femur using locking plates. Mean age was 72.4 years, 40 patients were female. Thirty-two patients (55.2%) had a total hip prosthesis, 21 a total knee prosthesis and 5 both types of prosthesis (8.6%). We noted: peri- and postoperative complications, degree of bone healing, degree of mobility (Barthel Mobility index and stand up and go test) as well as the social status of the patients.

Results: Bone healing was obtained in 56 cases (96.5%). In two patients, the implant was dislocated and in four others there were general complications. The mean time necessary to obtain total weight-bearing two-leg stance was 8.6 weeks. Forty-six patients (78%) had the same social status as before the fracture. For mobility, 52 patients (89%) achieved the same level as before fracture. Four other patients required a crutch for walking and two needed a walker. Mean Barthel index was 85 points (max 100) and improved 35 points at onset of rehabilitation. Mean stand up and go was 22 s.

Conclusion: According to the review of the literature, 35% of plates dislocate after osteosynthesis of periprosthetic fractures. In our study, the rate was 3.5%, with 7% general complications. We can thus conclude that the methods presented here enable good bone healing in the majority of cases.