OTA 2012 Posters

Scientific Poster #29 Hip/Femur OTA-2012

Surgical Fixation of Vancouver Type B1 Periprosthetic Femur Fractures: A Systematic Review

Niloofar Dehghan, MD; Aaron Nauth, MD; Bill Ristevski, MD;
Michael D. McKee, MD; Emil H. Schemitsch, MD;
Division of Orthopaedics, St. Michael’s Hospital, University of Toronto,
Toronto, Ontario, Canada

Purpose: Periprosthetic fractures are a devastating complication of total hip arthroplasty. Type B1 periprosthetic fractures occur at the tip of a stable implant, and are usually treated with open reduction and internal fixation (ORIF). However, many different fixation techniques have been described, and there is a lack of consensus on the optimal technique. Current treatment strategies include the use of cortical strut allografts alone, cable plates or compression plates with/without cortical strut allografts, and locking plates. This systematic review of the literature investigates and compares the outcomes of these different treatment strategies.

Methods: A literature review was conducted focusing on surgical fixation of type B1 periprosthetic fractures. Two independent authors reviewed the potential studies, and 19 studies were included for final analysis. These were all retrospective case series, with no randomized controlled studies or prospective cohort trials found in the literature. Studies were analyzed and categorized depending on the method of fixation: group 1, ORIF with strut allografts alone; group 2, ORIF with cable plate/compression plates alone; group 3, ORIF with cable plate/compression plates and cortical strut allograft; and group 4, ORIF with locking plates. Data analysis was performed comparing rates of nonunion, malunion, hardware failure, infection, reoperation, and total complications.

Results: 19 studies were identified with a total of 280 patients at the final analysis. The rate of total complications for all patients (N = 280) was 34%: nonunion, 5%; malunion >5°, 6%; hardware failure, 5%; infection, 5%; and reoperation 12%. These varied between the four different fixation groups. Cortical struts allografts alone were used in 26 patients, cable plate/compression plates were used in 149 cases, cable plate/compression plates with cortical strut allografts were used in 42 cases, and locking plates were used in 63 cases. Locking plates had a significantly higher rate of total complications compared with the other three groups. The rate of total complications for locking plates (group 4) compared with the other three groups were as follows: versus group 1, 48% vs 19%, P = 0.02; versus group 2, 48% vs 30%, P = 0.02; versus group 3, 48% vs 29%, P = 0.04. There was also a significantly higher rate of hardware failure of locking plates compared with group 2 (14% vs 3%, P = 0.007), and a trend toward higher rate of hardware failure compared with group 3 (14% vs 2%, P = 0.07). Compared with group 1, locking plates had a trend towards higher rates of nonunion (4% vs 11%, P = 0.06) and reoperation (19% vs 4%, P = 0.10). Locking plates showed a trend toward a lower rate of malunion compared with group 1 (2% vs 12%, P = 0.08) and group 3 (2% vs 10%, P = 0.10).

Conclusion: This systematic review suggests that with regard to fixation of type B1 periprosthetic femur fractures, locking plates have significantly higher rates of total complications compared with the other three fixation options, and a significantly higher rate of hardware failure compared to cable plate/compression plates. There are limitations to this study, and further investigation with high-quality randomized controlled trials is needed to further assess these outcomes.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.