Periprosthetic femoral shaft fractures are a significant complication of total hip arthroplasty. Plate osteosynthesis with or without onlay strut allograft has been the mainstay of treatment around well-fixed stems. Nonunions are a rare, challenging complication of this fixation method. The number of published treatment strategies for periprosthetic femoral nonunions are limited. In this series, we report the outcomes of a novel orthogonal plating surgical technique for addressing nonunions in the setting of Vancouver B1 and C-type periprosthetic fractures that previously failed open reduction internal fixation (ORIF). A retrospective chart review of all patients from 2010 to 2014 with Vancouver B1/C total hip arthroplasty periprosthetic femoral nonunions was performed. All patients were treated primarily with ORIF. Nonunion was defined as no radiographic signs of fracture healing nine months post-operatively, with or without hardware failure. Exclusion criteria included open fractures and periprosthetic infections. The technique utilised a mechanobiologic strategy of atraumatic exposure, resection of necrotic tissue, bone grafting with adjuvant recombinant growth factor and revision open reduction internal fixation. Initially, compression was achieved using an articulated tensioning device and application of an anterior plate. This was followed by locked lateral plating. Patients remained non-weight bearing for eight weeks. Six Vancouver B1/C periprosthetic femoral nonunions were treated. Five patients were female with an average age of 80.3 years (range 72–91). The fractures occurred at a mean of 5.8 years (range 1–10) from their initial arthroplasty procedure. No patients underwent further revision surgery; there were no wound dehiscence, hardware failures, infections, or surgical complications. All patients had a minimum of nine months follow up (mean 16.6, range 9–36). All fractures achieved osseous union, defined as solid bridging callus over at least two cortices and pain free, independent ambulation, at an average of 24.4 weeks (range 6.1–39.7 weeks). To our knowledge, this is the first case series describing 90–90 locked
Biological reconstruction techniques after diaphyseal tumour resection have increased in popularity in recent years. High complication and failure rates have been reported with intercalary allografts, with recent studies questioning their role in limb-salvage surgery. We developed a technique in which large segment allografts are augmented with intramedullary cement and fixed using
Aims. Compression and absolute stability are important in intra-articular fractures such as transverse olecranon fractures. This biomechanical study aims to compare tension band wiring (TBW) with plate fixation by measuring compression within the fracture. Methods. A cross-over design and synthetic ulna models were used to reduce variation between samples. Identical transverse fractures were created using a 0.5mm saw blade and cutting jig. A Tekscan(tm) force transducer was calibrated and placed within the fracture gap. Twenty TBW or Acumed(tm) plate fixations were performed according to the recommended technique. Compression was measured while the constructs were static and during simulated elbow range of movement exercises. Dynamic testing was performed using a custom jig reproducing cyclical triceps contraction of 20N and reciprocal brachialis contraction of 10N. Both fixation methods were tested on each sample. Half were randomly allocated to TBW first and half to plating first. Data was recorded using F-scan (v 5.72) and analysed using SPSS(tm) (v 16). Paired T-tests compared overall compression and compression at the articular side of the fracture. Results. The mean overall
