Locking plate fixation of periprosthetic femur fractures with and without cerclage wires

Abstract

Objective: The number of patients requiring knee and hip arthroplasty has been steadily increasing, and periprosthetic fractures are on the rise. Locking plates are the most common treatment for periprosthetic fractures, but the use of cerclage wires with locking plate fixation has been controversial.

Methods: Forty-seven patients with periprosthetic femur fractures were reviewed retrospectively. Twenty-four patients received locking plate alone and twenty-three patients were treated with locking plate and cerclage wires. Patients were evaluated for clinical and radiographic signs of union at two, six, twelve, twenty-four, and forty-eight weeks postoperatively.

Results: The average follow-up time in the plate group was 9.4 ± 6.7 months, while it was 6.0 ± 4.2 months in the cerclage wire group. The time to union in the cerclage wire group (3.6 ± 1.0 months) was significantly less than the plate group (4.8 ± 2.6 months). The group with the cerclage wires had a significantly lower revision rate of 0% compared to 20.8%. There was no statistical significance of union rate and complication rate between the two groups.

Conclusion: Cerclage wires used with locking plate fixation successfully treats periprosthetic fractures of the femur with faster time to union, less complication, and fewer revisions.

Keywords: Cerclage wires; Femur; Locking plate; Periprosthetic fractures.

© 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Figures

Figure 1

The placement of locking plate and a minimum of two proximal and distal Dall‐Miles cables to successfully reduce and fix the periprosthetic femur fracture.

Figure 2

Periprosthetic femur fracture in patient with total hip replacements. (a) Displays anteroposterior view preoperatively. (b) anteroposterior view and (c) axial view show postoperative views: Fracture healing well 5 months after locking plate and Dall‐Miles cables successfully reducing and fixating the fracture site.

Figure 3

Periprosthetic femur fracture treated with locking plate. (a) After 8 months the plate failed fixation resulting in delayed union. (b) Seven months after treating with revision and allograft, the fracture is healed. (c) After 2 year follow‐up, the fracture remolded well.