Abstract
Background
Periprosthetic fracture fixation can be a difficult and complex procedure. The incidence of such fractures is increasing relative to the high prevalence of elderly patients with joint arthroplasty and osteoporosis. Locking plates were introduced for the management of complex periarticular fractures in osteoporotic bone, but there is little information on the use of these plates for the management of periprosthetic fractures. The purpose of this study was to review the early experience with these plates in managing complex Vancouver B1 and C periprosthetic fractures at our academic centre to determine the effectiveness in achieving union, and to identify any potential complications associated with their use.
Methods
We evaluated the results of Vancouver B1 and type C periprosthetic fractures treated with Synthes LCP. The mean age of the patients at the time of surgery was 76 years. 5 patients were men and 10 were women. There were 8 Vancouver B1 and 7 Vancouver C fractures. 6 fractures had failed previous operative treatment. No patient was lost to follow-up. We assessed time to union, complications, and identified criteria for cortical fixation using these plates.
Results
At the time of the most recent follow-up, all patients had gone on to radiographic union. Time to union was 6 months. All patients continue to have pain, and all continue to use walking aids. We discuss technical considerations, plate length, fixation and use of allograft.
Conclusion
The Synthes Locking Plate system has been shown to provide good results for use in Type C and B1 periprosthetic fractures. Complications were surprisingly low considering the age group involved and associated co-morbidities. Surgery is complex requiring approximately 4 hours with expected blood loss of > 1 litre. Rehabilitation can be slow and prolonged but all patients were ambulatory at 1 year.
