Hip Pelvis.  2012 Sep;24(3):213-221. 10.5371/hp.2012.24.3.213.

Operative Treatment of Periprosthetic Unstable Femoral Fractures of Vancouver Type B1 and C with Variable Plates

• Cha SH
• Shin WC
• Suh KT

• KMID: 2054135
• DOI: http://doi.org/10.5371/hp.2012.24.3.213

Abstract

PURPOSE
The purpose of this study is to evaluate the outcome after operative treatment with plate fixation in Vancouver B1 and C periprosthetic unstable femoral fractures.
MATERIALS AND METHODS
We conducted a retrospective assessment of 15 patients who had under gone treatment for a periprosthetic unstable femoral fracture around primary hip arthroplasty between April 1997 and July 2010. The mean age of patients was 69 years(53 to 82 years) at the time of surgery and the mean duration of follow-up was 29.2 months (six to 110 months). According to Vancouver classification, 10 patients were type B1 and five were type C. According to the time of operation, open reduction and internal fixation was performed using four different plates. Bone graft was applied in all patients, regardless of the type of plate. The present review describes the clinical and radiographic results.
RESULTS
All patients were able to ambulate without assistance of crutches or walkers. Of the 15 patients, the fracture site was united in all patients. Postoperative dislocation of the ipsilateral hip was observed in one patient; however, there was no occurrence of further complications, such as infections, nerve injuries, or loosening of the femoral stems.
CONCLUSION
In Vancouver type B1 and C fractures, without any loosening of the femoral stems, open reduction with plate fixation using our operative methods provided a satisfactory result.

Keyword

Femur; Periprosthetic fracture; Vancouver B1; Vancouver C; Plate fixation

MeSH Terms

Arthroplasty
Crutches
Dislocations
Femoral Fractures
Femur
Follow-Up Studies
Hip
Humans
Periprosthetic Fractures
Retrospective Studies
Transplants
Walkers

Figure

• 

  Fig. 1 A 73-year-old female that sustained a Vancouver B1 fracture after total hip arthroplasty with cementless femoral component. Treatment by open reduction and internal fixation with reversed LCDCP and additional cable wires. (A) Preoperative anteroposterior roentgenogram. (B) Preoperative computed tomography shows no evidence of femoral stem loosening. (C) The anteroposterior roentgenogram at last follow-up shows that the fracture is stably fixed with plate, screws and cables, and additional proximal fixation with cancellous screw to greater trochanter of the femur was done. Complete union was gained.

• 

  Fig. 2 (A) The plain anteroposterior roentgenogram of a 61-year-old male with Vancouver B1 fracture. Treatment by open reduction and internal fixation with broad DCP and wires. (B) The plain anteroposterior roentgenogram of a 53-year-old male with Vancouver C fracture. Treatment by open reduction and internal fixation with anatomical LCP and wires.

• 

  Fig. 3 Three different plates are able to fix cables or wires. (A) Cable-Ready® Cerclage Plate, Zimmer. (B) Dall-Miles Cable Plate, Stryker. (C) Low Contact Dynamic Compression Plate (LCDCP), AO. LCDCP has the shortest distances between adjacent grooves for fixation of cables or wires.

• 

  Fig. 4 We flipped LCDCP inside out. The grooves for low contact surface may be used for cable fixation.

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