Session VI - Geriatric Trauma

The Partridge Osteosynthesis: A Prospective Clinical Study on the Use of Nylon Cerclage Bands and Plates in the Treatment of Subprosthetic Femoral Shaft Fractures

Victor A. De Ridder, MD, Prof. F. Heatley, Prof. P. Klopper, S. de Larye

Westeinde Hospital, Lynbaan, Holland

Purpose: To evaluate the clinical use of the Partridge osteosynthesis in subprosthetic femoral fractures.

Material and Methods: Over a 10 year period 222 patients presenting with femoral fractures near the tip of a Total Hip Prosthesis were treated with the Partridge system, which employs elevated cerclage nylon bands and flexible elevated nylon plates. Sixty-five fractures were located cranially to the tip of the THP (Whittaker type I), 116 at the tip (type II) and 41 distally of the tip of the THP (type III); 172 female and 50 male patients, mean age of 79.5 years. The majority of the patients were older than sixty-five years of age: 87.5%. The mean duration between moment of implant of the THP and occurrence of the fracture was 1.5 years.

In 78% (173/222) surgery was undertaken within 48 hours. The fracture reduction was open and temporarily held with one or two nylon bands or clamps. Two nylon plates set at right angles to each other were then secured to the femur with six to eight nylon bands. The mean operating time was 55 minutes (open-to-closed) with an average blood loss of about 550 ml.

Postoperatively most patients (>75%) were taken out of bed the day after the operation, the operated leg was supported during mobilization and weight bearing begun when sufficient callus was seen on the X-rays, in general after three to six weeks.

Results: Minor wound healing problems occurred in 18 patients (12.6%), there were no deep wound infections. Thirty-three elderly patients died within the first month from medical complications, but no death was directly caused by a surgical complication. Of the 189 surviving patients six month postoperatively, about 60% regained their prefracture functional level, about 25% required a higher level of care.

The mean time for in-hospital stay was 33 days before the patients could be transferred to reconvalescence care.

Nearly all fractures (93%) consolidated with abundant callus during the follow-up of one year. There was no significant loss of fracture position such that it influenced the functional outcome or necessitated a second operation.

Discussion: The indication for the use of this simple osteosynthesis method is swift reconvalescence of these elderly patients. Other methods as replacement of the THP, supplemented by either cerclage or plates and screws with the aid of bone cement are elaborate, complicated and prone to complications. Even with a loose prosthesis, the fracture often healed with abundant callus and the patient could be mobilized. This osteosynthesis has been the subject of mechanical testing, has been used in an experimental setting in dogs and rabbits to clarify the suspected vascularization problems of the cortex.

Conclusion: These results support the claims made by the late Mr. Partridge for his system of managing this difficult clinical problem of periprosthetic femoral fractures in these elderly, frail patients.