Locking plate osteosynthesis for Vancouver Type B1 and Type C periprosthetic fractures of femur: a report on 12 patients

Abstract

Many methods have been described to stabilise periprosthetic fractures around a total hip arthroplasty. Locking plate fixation offers increased angular stability and, theoretically, better fixation in osteoporotic bone. This study presents our results with the use of locking plate fixation for Vancouver Type B1 and Type C periprosthetic fractures following total hip arthroplasty (THA). Twelve patients underwent fixation of periprosthetic fractures with either a locking compression plate (LCP) or a distal femur less invasive stabilisation system (LISS). There were six Type B1 and six Type C fractures. One patient died soon after surgery. The mean follow-up was 13.9 months (range 12-18 months). The fracture healed in 10 of the remaining 11 patients with a median time to union of 4.8 months. There was one implant failure prior to fracture healing and one implant failure after fracture healing. Both were attributed to technical errors. Seven patients returned to their previous level of mobility. Two patients required the use of one walking stick after fracture healing, but had been able to walk unaided before their fall. One patient required two sticks, after previously requiring only a single stick. There were no infections. Our experience encourages us that locking plates have a role to play in managing periprosthetic fractures around a stable femoral stem, especially in patients with poor soft tissue and osteoporosis.