Achieving Construct Stability in Periprosthetic Femur Fracture Treatment

One of the greatest challenges in treating patients with periprosthetic femoral fractures is achieving bone fixation in the presence of a well-fixed stem. Three techniques are described, which allow for improved fixation. A clinical series of fourteen patients with periprosthetic femur fractures that underwent open reduction internal fixation utilizing these techniques were reviewed. Thirteen patients had clinical and radiographic union. One patient required conversion to a revision total hip arthroplasty when it was noted that he had a loose prosthesis. Average time to radiographic union was 122 days. The described techniques allow surgeons to obtain multiple points of fixation around the prosthesis in an effective manner. 1. Introduction The incidence of periprosthetic femoral fractures is increasing, likely due to the larger number of total knee and hip arthroplasties being performed and the increased survivorship of the arthroplasty population [1–3]. Fractures can occur during the initial arthroplasty or at any time postoperatively. The incidence of postoperative periprosthetic fracture of the knee and hip ranges from 0.5% to 2.5% [4, 5]. The majority of these fractures can be classified as fragility fractures, due to the fact that they occur from a relatively low energy mechanism [2]. These fractures are challenging to treat due to host factors, such as poor bone quality, as well as the complex mechanical interplay between fracture and arthroplasty implants. A variety of treatment options are available to orthopaedic surgeons who treat these fractures. There is no single approach that can be used to treat such a heterogeneous group of fractures. Generally speaking, most femur fractures that occur below a hip prosthesis should be stabilized. Vancouver B2 and B3 types, those with loose arthroplasty components, should be revised with stems that extend beyond the fracture [3]. Nonoperative management is reserved for cases of stable trochanteric fractures around a well-fixed implant (Vancouver A), or those in patients who are unable to undergo surgical treatment. Displaced fractures are seldom treated with nonoperative modalities due to the unacceptable rate of complications [6]. Many fractures occur below a well-fixed stem, the Vancouver B1 and Vancouver C fractures. These fractures are indicated for open reduction and internal fixation. The goal of surgical fixation is restoration of anatomic alignment which leads to early postoperative mobilization and return to function. Stable fixation is achieved to promote bony union. Fixation options include