Locking plate fixation for Vancouver B1 periprosthetic femoral fractures: A critical analysis of 135 cases

Purpose: The overall incidence of periprosthetic femoral fractures (PPF) is between 0.1 and 6 % of all total hip arthroplasties. Locking compression plates (LCP) have been used for the treatment of Vancouver B1 PPFs with variable results. The aim of this study is to examine the literature on locking plate failure rates, mode and reasons for failure. Methodology: A literature search was conducted for studies reporting the management of PPF of the femur with LCP fixation. The primary medical search engines used for the study were Ovid MEDLINE and EMBASE databases up to August 2012. Results: Twelve studies were identified, reporting overall union rates of 91 % in 135 fractures. Only 7 (5 %) fractures required revision surgery due to plate fracture (5) or pull out (2). Important trends in plate complications included: stress riser at the end of the plate, stress concentration in the fracture area due to rigid fixation, early loading and absence of cortical strut grafting for biological support when needed. Conclusion: LCP has been used successfully in the management of Vancouver B1 PPF. However, potential areas of improvement include, leaving the fracture site free of locking screws, therefore, not disturbing the soft tissue envelope around the fracture and also reducing plate stiffness. Adding cortical strut allografts to improve stability and bone quality, if needed, may also improve outcome. Limitations in the use of strut grafts or transverse fractures below the tip of the stem that cannot be controlled with single or double plating may require long stem revision to achieve axial stability. © 2013 The Japanese Orthopaedic Association.