Twelve pairs of fresh-frozen, cadaveric femora were harvested. Each right femur was prepared for the cemented insertion of the femoral component of a total hip implant. Left femora served as matched intact controls. Following insertion of the implants, the distal tip of the stem was identified and an oblique osteotomy was made to represent a periprosthetic fracture. Proximally, plates were secured with cables and distally by bicortical screw fixation (c+s). The twelve pairs of femora were randomly divided into three groups: 1. Zimmer Cable-Ready System, 2. AO 4.5 mm broad, LC-DCP, with Wire Mounts and Double Luque Wires, 3. Dall-Miles Cable Grip System. Specimens were mounted and deforming forces were applied to test the biomechanical stiffness of the constructs. Following testing the plate-cable combinations, the proximal cables were removed and replaced with unicortical screws (s+s). Repeat testing was then performed as per the above protocol.

The stiffness of the constructs relative to intact bone decreased (p< 0.05) with fixation utilising cables plus screws (c+s) during four-point bending (69–77%) and offset rotational loading (61–64%). When testing unicor-tical plus bicortical screw fixation (s+s) in these modes, a similar effect was seen. There was no difference between plate systems (ANOVA, p> 0.05). Comparisons of stiffness between cable plus screw combination versus unicor-tical plus bicortical screw combination revealed that the latter method of fixation (s+s) was more rigid (p< 0.05).

Our study showed that the three plate-cable systems displayed similar biomechanical stiffness. In addition, when the cables were replaced proximally with unicortical screws, more rigid fixation was obtained in all but one plane of testing.

We conclude that the method of plate stabilisation by screws or cables is more significant than the type of plate used for periprosthetic fracture stabilisation.