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. 2022 May 3:13:21514593221100417.
doi: 10.1177/21514593221100417. eCollection 2022.

Use of the Locking Attachment Plate for Internal Fixation of Periprosthetic Femur Fractures

Bryce Wall  1 , Jeffrey B Stambough  1 , Steven M Cherney  1 , Simon C Mears  1
Affiliations

Use of the Locking Attachment Plate for Internal Fixation of Periprosthetic Femur Fractures

Bryce Wall et al. Geriatr Orthop Surg Rehabil. .

Abstract

Introduction: The locking attachment plate (LAP) can be added to a locking compression plate (LCP) to allow the fixation of locking screws bicortically around a femoral implant. We aimed to examine surgical and fracture characteristics associated with healing for periprosthetic femur fractures (PPFFx) treated with constructs employing LAP fixation. We hypothesize that the addition of an LAP provides stable peri-implant fixation.

Materials &methods: We retrospectively reviewed a consecutive series of 28 PPFFx surgically treated with LCP-LAP constructs by 4 surgeons from 2015-2020. Fractures were classified and grouped using the Vancouver Classification System and included 12 B1, 2 B2, 11 C fractures, and 3 fractures around other stemmed implants. Primary outcome measures included hardware failure such as screw pullout, broken screws, and plate fracture. Clinical complications including infection, non-union, malunion, and reoperation were recorded.

Results: No LAP failures, screw pullout, or broken screws were observed. Two fractured plates (7.1%) occurred in patients with Vancouver C fracture types. Overall complication rate was 17.9% and included 3 non-unions, 1 deep infection, and 1 implant loosening with painful hardware, each requiring reoperation. Differences were observed between unions and nonunions for total number of screws (12.4 vs 14.7, P = .005) and number of locking screws used (8.04 vs 11.3, P = .03).

Conclusion: The LAP provides adequate fixation and low failure rates where fixation is required around a well-fixed stem. When failures occur, it is from plate breakage and not due to failure of fixation at the area of plate-stem overlap.

Keywords: femur fracture; fixation; locking plate attachment; periprosthetic fracture; plate.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Intraoperative image of LAP-LCP construct.
Figure 2.
Figure 2.
Postoperative lateral radiograph demonstrating placement of LAP-LCP construct.
Figure 3.
Figure 3.
(A) and (B): Injury radiographs of single individual sustaining bilateral Vancouver B1 fractures.
Figure 4.
Figure 4.
(A) and (B): 12 month post-op, bilateral Vancouver (B) 1 fractures treated with LAP-LCP.
Figure 5.
Figure 5.
(A) and (B): (A) A. Post-op AP femur, Vancouver C fracture with bone defect, (B) AP femur, 8 months post-op Vancouver C fracture non-union with plate fracture.
Figure 6.
Figure 6.
(A) and (B): (A) Post-op AP femur, Vancouver C fracture. (B) AP femur, 5 months post-op Vancouver C fracture non-union with plate fracture.
See this image and copyright information in PMC

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