Hip Pelvis.  2019 Sep;31(3):166-173. 10.5371/hp.2019.31.3.166.

Prognostic Factors and Clinical Outcomes after Treatment of Periprosthetic Femoral Fractures Using a Cable-plate

• Kang JS
• Moon KH
• Ko BS
• Roh TH
• Na Y
• Youn YH
• Park JH

• KMID: 2455990
• DOI: http://doi.org/10.5371/hp.2019.31.3.166

Abstract

PURPOSE
To analyze prognostic factors for the treatment of periprosthetic femoral fractures (PFFs) using the cable-plate construct.
MATERIALS AND METHODS
A retrospective review of a consecutive series of 41 PFFs treated by osteosynthesis using the cable-plate system. The mean age of patients was 67.3±12.1 years (range, 42-86 years) and the mean follow-up period was 31.5±11.6 months (range, 12-58 months). Fresh frozen cortical strut allografts were leveraged in three cases for additional stability. Prognostic factors that may potentially affect clinical outcomes were analyzed.
RESULTS
At the time of final follow-up, fracture union was obtained in 29 hips (70.7%; Group I) after an average of 13.5 weeks (range, 12-24 weeks). Healing failure after surgical treatment was observed in 12 cases (29.3%; Group II), including delayed union (n=10) cases and nonunion (n=2). Factors significantly associated with fracture union included fracture pattern (P=0.040), plate overlap percentage to stem length (P<0.001) and T-score at the preoperative bone mineral density (P=0.011). Transverse-type fractures around or just distal to a well-fixed femoral stem were observed in six cases (50.0%) of Group II.
CONCLUSION
The cable-plate osteosynthesis of PFFs should be performed with caution in transverse-type fractures or in cases with severe osteoporosis. Fixation with sufficient plate overlap to stem length may be critical to prevent healing failure.

Keyword

Total hip replacement; Periprosthetic fractures; Cable-plate construct

MeSH Terms

Allografts
Arthroplasty, Replacement, Hip
Bone Density
Femoral Fractures*
Follow-Up Studies
Hip
Humans
Osteoporosis
Periprosthetic Fractures
Retrospective Studies

Figure

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  Fig. 1 Description of plate overlap percentage (%) to stem length. B/A×100 (%).A: whole stem length, B: plate overlap to stem length.

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  Fig. 2 (A) Preoperative X-ray of a 57-year-old male with Vancouver type B1 spiral fracture, having severe osteoporosis with bone mineral density −3.8, who visited after slip down. (B) Postoperative X-ray after open reduction and internal fixation carried out with cable-plate construct. Fracture union was obtained four months after surgery. (C) Follow-up X-ray two years after surgery showing good union and stable fixation of femoral stem.

• 

  Fig. 3 (A) Preoperative X-ray of a 72-year-old female with a Vancouver type B1 transverse fracture around or just distal to a well-fixed femoral stem, having severe osteoporosis with bone mineral density −4.0, who visited after slip down. (B) Postoperative X-ray after open reduction and internal fixation carried out with cable-plate construct. (C) Follow-up X-ray 10 months after surgery showing delayed union.

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