93.
The Locking Attachment Plate in surgery of periprosthetic femur
fractures in THA patients: A review of reoperations in 89 cases from two
centers.
Zaid Issa, Ilija Ban, Kim Holck, Lonnie Froberg, Michael Brix, Anders
Troelsen
Dept. of Orthopaedics Hvidovre University Hospital; Dept. of Orthopaedics,
Hvidovre University Hospital; Dept. of Orthopaedics, Hvidovre University
Hospital; Dept. of Orthopaedics, Odense University Hospital; Dept. of
Orthopaedics, Odense University Hospital; Dept. of Orthopaedics, Hvidovre
University Hospital
Background:
Stable fixation with plate osteosynthesis of periprosthetic femur
fractures in THA patients can be challenging. Insufficient primary fixation
may lead to failure of osteosynthesis. Locking attachment plates (LAP) used in
conjunction with long locking compression plates has been introduced to
enhance fixation. The potential benefits of the LAP remain unexplored.
Purpose / Aim of Study:
To investigate the rate of intraoperative
complications and reoperations following plate osteosynthesis of periprosthetic
femur fractures with and without LAP’s.
Materials and Methods:
At two centers we identified patients with THA’s
operated for Vancouver type B and C periprosthetic fractures either with
utilization of the LAP in the period 08-12 (n=29) or without the LAP in the
period 04-07 (n=60). Age and gender distribution were comparable between
groups. Patient files and radiographic material were used to assess
complications and reoperations. Fracture types were: B1=11, B2=5, B3=3,
C=10 in the LAP group, and B1=13, B2=2, B3=8, C=37 in non-LAP group.
Findings / Results:
There were no intraoperative complications. Reoperations
within one year were performed in 8 of 29 cases in the LAP group (28%), and
in 19 of 60 cases in the non-LAP group (30%). Failure of osteosynthesis was
the reason for reoperation in 1 case in the LAP group, and 12 cases in the non-
LAP group. Infection accounted for 7 cases of reoperation in the LAP group,
and 4 cases of reoperation in the non-LAP group. New periprosthetic fractures
were the reason for reoperation in 3 cases in the non-LAP group.
Conclusions:
It seems that the LAP can facilitate improved fracture fixation.
However, the total rate of reoperations is only marginally reduced with
infection still representing a major cause of revision.
