Surgical outcomes of cable plate fixation in treatment of Vancouver type B1 and type C periprosthetic femoral fractures: a retrospective case series

Abstract

Objective: This study aimed to investigate the mid-to-long-term surgical outcomes of open reduction and internal fixation (ORIF) using a hybrid locking plate/cable technique for the treatment of Vancouver type B1 and type C periprosthetic femoral fractures (PPFs) in a consecutive group of patients from a single tertiary referral center. Methods: Twenty-five patients (25 PPFs; 17 female, 8 male) in whom a Vancouver type B1 or type C PPF was diagnosed and treated by a hybrid locking plate/cable technique from 2005 to 2016 were included in the study. Patients’ functional status was categorized into 4 groups based on the Harris Hip Score (HHS) at the final follow-up: 70=poor result; 70-80=fair; 80-90=good, and 90-100=excellent. Intraand postoperative complications were also recorded. PPF union was defined clinically as the patient’s ability to bear full weight with or without assistance and radiographically as the presence of a callus bridging the fracture. Subgroup analyses were conducted according to the Vancouver classification and type of fixation regarding the HHS and time to union. Results: The mean age was 57 ± 16.6 (range, 17-82) years at the time of the primary hip replacement and 64 ± 18.7 (range, 24-88) years at the time of PPF. The mean follow-up was 5.6 ± 3.3 (range, 2-14) years from primary procedure to PPF and 6.5 ± 4.1 (range, 3-15) years following PPF. There were 7 type B1 and 18 type C PPFs. At the final follow-up, the mean HHS was 71 ± 7.74 (range, 57-89). According to HHS, functional results were poor in 8 patients, fair in 14 patients, and good in 3 patients. No major intra- or postoperative complications were noted. Fracture union was achieved in all patients without complications at an average of 13 ± 4.9 (range, 6-24) weeks. In subgroup analysis, while no significant differences were observed in the HHS (P=.87 for the Vancouver type, P=.96 for the type of fixation), time to union differed among groups. Time to union was significantly shorter in type B1 than in type C PPFs (P=.006). Time to union was considerably shorter in the uncemented group compared to the cemented one (P=.017). Conclusion: Adding cables to the locking plate can provide adequate stability to preserve fracture alignment and achieve bony union in Vancouver type B1 and C PPFs. Although union can be achieved by ORIF in such patients, a longer union time may be required for PPFs in the setting of a cemented femoral stem or Vancouver type C. Level of Evidence: Level IV, Therapeutic study.