Are proximal screws necessary for osteosynthesis of stable-stem periprosthetic femoral fractures fixed with non-locking plate and cable?. Issue 10 (October 2019) - Yang, Tzu-Cheng
Highlights: Cable-plate-cable technique sufficiently treats Vancouver types B1 and C periprosthetic femoral fractures without use of additional screws in the proximal fragment. Surgical dislocation should be performed for all cases in which the stability of the implant remains controversial. Proximal fragment fixation with cables alone has the advantage of easier femoral revision of exchanging the stem, such as femoral stem loosening or conversion to total hip replacement. Abstract: Introduction: The purpose of this study was to assess the effectiveness of the cable-plate-cable technique which comprises fixation of the proximal fragment using cable loops without additional proximal screws on the plate for the treatment of stable-stem periprosthetic femoral fractures around hip prostheses. Methods: We retrospectively reviewed Vancouver types B1 and C periprosthetic femoral fractures treated with a dynamic compression plate combined with Dall-Miles cable between 2010 and 2016 at a single institution and followed for at least 12 months. Patients were treated with proximal fragment fixation using cable combined with screws (Group I) or with proximal fragment fixation using cable alone (Group II). Demographic data, fracture types, and clinical and radiological outcomes were analyzed. Results: A total of 50 patients were included (Group I, n = 23 patients; Group II, n = 27). Fracture union was achieved in 49 patients with one case of non-union in Group I and no cases of non-union in Group II. Mean time to union was 5.4 months in Group I and 5.1 months in Group II (P = 0.624). Mean Harris hip score at latest assessment was 69.5 in Group I and 69.4 in Group II (P = 0.919). Regarding complications, there was one deep wound infection, one stem subsidence, and one loss of reduction in Group I, and one stem subsidence in Group II. No significant difference in clinical and radiological outcomes between groups was observed. Conclusions: The cable-plate-cable technique sufficiently treats Vancouver types B1 and C periprosthetic femoral fractures without use of additional screws in the proximal fragment.