Operative Treatment of Periprosthetic Unstable Femoral Fractures of Vancouver Type B1 and C with Variable Plates

Seung Han Cha; Won Chul Shin; Kuen Tak Suh

doi:10.5371/hp.2012.24.3.213

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Cha, Shin, and Suh: Operative Treatment of Periprosthetic Unstable Femoral Fractures of Vancouver Type B1 and C with Variable Plates

Original Article

Hip & Pelvis

Hip & Pelvis 2012; 24(3): 213-221.

Published online: 30 September 2012

DOI: https://doi.org/10.5371/hp.2012.24.3.213

Operative Treatment of Periprosthetic Unstable Femoral Fractures of Vancouver Type B1 and C with Variable Plates

Seung Han Cha, MD, Won Chul Shin, MD, Kuen Tak Suh, MD, PhD

Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.

Address reprint request to Won Chul Shin, MD. Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea. TEL: +82-55-360-2125 FAX: +82-55-360-2155, dreami3e5t@pusan.ac.kr

Received 4 May 2012 Revised 18 September 2012 Accepted 18 September 2012

(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/3.0) 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 outcome after operative treatment with plate fixation in Vancouver B1 and C periprosthetic unstable femoral fractures.

Materials and Methods

We conducted a retrospective assessment of 15 patients who had under gone treatment for a periprosthetic unstable femoral fracture around primary hip arthroplasty between April 1997 and July 2010. The mean age of patients was 69 years(53 to 82 years) at the time of surgery and the mean duration of follow-up was 29.2 months (six to 110 months). According to Vancouver classification, 10 patients were type B1 and five were type C. According to the time of operation, open reduction and internal fixation was performed using four different plates. Bone graft was applied in all patients, regardless of the type of plate. The present review describes the clinical and radiographic results.

Results

All patients were able to ambulate without assistance of crutches or walkers. Of the 15 patients, the fracture site was united in all patients. Postoperative dislocation of the ipsilateral hip was observed in one patient; however, there was no occurrence of further complications, such as infections, nerve injuries, or loosening of the femoral stems.

Conclusion

In Vancouver type B1 and C fractures, without any loosening of the femoral stems, open reduction with plate fixation using our operative methods provided a satisfactory result.

Keywords: Femur, Periprosthetic fracture, Vancouver B1, Vancouver C, Plate fixation

Figures and Tables

Fig. 1

A 73-year-old female that sustained a Vancouver B1 fracture after total hip arthroplasty with cementless femoral component. Treatment by open reduction and internal fixation with reversed LCDCP and additional cable wires. (A) Preoperative anteroposterior roentgenogram. (B) Preoperative computed tomography shows no evidence of femoral stem loosening. (C) The anteroposterior roentgenogram at last follow-up shows that the fracture is stably fixed with plate, screws and cables, and additional proximal fixation with cancellous screw to greater trochanter of the femur was done. Complete union was gained.

Fig. 2

(A) The plain anteroposterior roentgenogram of a 61-year-old male with Vancouver B1 fracture. Treatment by open reduction and internal fixation with broad DCP and wires. (B) The plain anteroposterior roentgenogram of a 53-year-old male with Vancouver C fracture. Treatment by open reduction and internal fixation with anatomical LCP and wires.

Fig. 3

Three different plates are able to fix cables or wires. (A) Cable-Ready® Cerclage Plate, Zimmer. (B) Dall-Miles Cable Plate, Stryker. (C) Low Contact Dynamic Compression Plate (LCDCP), AO. LCDCP has the shortest distances between adjacent grooves for fixation of cables or wires.

Fig. 4

We flipped LCDCP inside out. The grooves for low contact surface may be used for cable fixation.

Table 1

Demographic Data of Patients

^*FU: Follow Up, ^†AVN: Avascular Necrosis, ^‡FNF: Femoral Neck Fracture, ^§THA: Total Hip Arthroplasty, ^∥BE: Bipolar Endoprosthesis, ^¶DCP: Dynamic Compression Plate, ^**LCDCP: Low Contact Dynamic Compression Plate, ^††LCP: Locking Compression Plate.

Table 2

Radiologic and Clinical Results

^*BMD: Bone Mineral Densitometry, ^†HHS: Harris Hip Score, ^‡DCP: Dynamic Compression Plate, ^§LCDCP: Low Contact Dynamic Compression Plate, ^∥LCP: Locking Compression Plate.

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