The Clinical and Radiological Results of Vancouver Type B1 and C Periprosthetic Fractures

Bo-Ram Na; Taek-Rim Yoon; Kyung-Soon Park

doi:10.12671/jkfs.2016.29.1.26

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Na, Yoon, and Park: The Clinical and Radiological Results of Vancouver Type B1 and C Periprosthetic Fractures

Original Article

Journal of the Korean Fracture Society 2016; 29(1): 26-33.

Published online: 19 January 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.1.26

The Clinical and Radiological Results of Vancouver Type B1 and C Periprosthetic Fractures

Bo-Ram Na, M.D., Taek-Rim Yoon, M.D., Ph.D., Kyung-Soon Park, M.D., Ph.D.

Department of Orthopaedic Surgery, Chonnam National University Medical School, Gwangju, Korea.

Address reprint requests to: Taek-Rim Yoon, M.D., Ph.D. Department of Orthopaedic Surgery, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea. Tel: 82-62-227-1640, Fax: 82-62-227-7794, tryoon@chonnam.ac.kr

Received 30 December 2014 Revised 24 July 2015 Accepted 30 November 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the clinical and radiologic results of plate fixation in the Vancouver B1 and C periprosthetic femoral fracture (PFF).

Materials and Methods

Twenty patients who had sustained a Vancouver type B1 and C periprosthetic fracture after hip arthroplasty (years 2002-2012) were identified. The mean age was 66.0 years (range, 43-85 years) and the mean follow-up duration of the group was 38 months (range, 12-102 months). The dynamic compression plate (DCP) group included 12 patients and the locking compression plate (LCP) group included eight patients. Harris hip score (HHS) and walking ability, knee joint range of motion (ROM) were compared before injury and last follow-up. Fracture union rate and period were compared.

Results

The mean HHS score was 90.7 (64-96). There was no statistical difference between the two groups. At the last follow-up, knee joint ROM was 103.3° (105°-140°) in the DCP group and 118.4° (110°-140°) in the LCP group, showing good results in the LCP group (p=0.043). No significant difference in the fracture union rate and union periods was observed between the two groups.

Conclusion

A better result for the postoperative knee flexion exercise capacity was observed in the LCP group. Use of LCP plate fixation is a good option in management of Vancouver classification B1 and C PFF.

Keywords: Total hip arthroplasty, Periprosthetic femoral fracture, Vancouver type B1 and C, Dynamic compression plate, Locking compression plate

Figures and Tables

Fig. 1

A 46-year-old male patient with a Vancouver type B1 periprosthetic fracture treated with open reduction and internal fixation dynamic compression plate and screws. (A) Preoperative radiograph. (B) Immediate postoperative radiograph. (C) Postoperative 3-year plain radiograph.

Fig. 2

A 72-year-old male patient with a Vancouver type C periprosthetic fracture treated with open reduction and internal fixation locking compression plate and screws. (A) Preoperative radiograph. (B) Immediate postoperative radiograph. (C) Postoperative 1-year plain radiograph.

Table 1

Demographic Data of the Two Groups

Variable	DCP (n=12)	LCP (n=8)
Sex (male/female)	8/4	3/5
Age (yr)	59.3 (43-80)	76.1 (70-85)
Vancouver classification
B1	4	1
C	8	7
Follow-up duration (mo)	43.2 (13-102)	30.2 (12-71)
Time interval from primary THA (mo)	96.8 (11-240)	66.4 (2-300)

Values are presented as number only or median (range). DCP: Dynamic compression plate, LCP: Locking compression plate, THA: Total hip arthroplasty.

Table 2

Clinical Outcomes of the Two Groups

Variable	DCP		LCP
Variable	Preoperative	Postoperative	Preoperative	Postoperative
HHS (0-100), median (range)	94.3 (86-100)	90.8 (79-96)	94.6 (82-100)	90.5 (64-96)
Pain (0-44), mean	41.7	39.8	40.8	37.2
Function (0-47), mean	44.6	42	45.8	44.3
Absenece of deformity (0-4), mean	4	4	4	4
ROM (0-5), mean	5	5	5	5
Walking ability, n
Independent walking, n	12	10	8	8
Crutch ambulation, n	0	2	0	0
Wheelchair ambulation, n	0	0	0	0
Knee ROM (°), median (range)		103.3 (105-140)		118.4 (110-140)

DCP: Dynamic compression plate, LCP: Locking compression plate, HHS: Harris hip score, ROM: Range of motion.

Table 3

Radiographical Findings of the Two Groups

Union of fracture site	DCP	LCP
Union	10	7
Delayed-union	2	1
Union period (mo)	5.5 (3-6)	5 (3-6)
Other complication
Infection	2	0
Metal breakage	1	1
Total	3	1

Values are presented as number only or median (range). DCP: Dynamic compression plate, LCP: Locking compression plate.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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