Objective: The periprosthetic fractures occur frequently in modern society, and Vancouver type B fractures have the highest incidence. Surgical treatment of fractures was necessary; however, the traditional operations have obvious disadvantages. This study aimed to explore the clinical efficacy of a novel technique—minimally invasive percutaneous plate osteosynthesis (MIPPO) combined with noncontact bridging plate for periprosthetic fracture (NCB.PP) for treating Vancouver type B femoral periprosthetic fractures.
Methods: The clinical data of 24 patients with Vancouver type B femoral periprosthetic fractures who were admitted between October 2018 and January 2023 were retrospectively analyzed. Fourteen were male and 10 were female; the average age was 74.82 ± 12.11 years (range 65–93 years). All patients underwent biological hip arthroplasty, including 14 total hip replacements and 10 hemi-arthroplasties. All patients were injured by falls, and the average time from injury to hip replacement was 17.16 ± 7.17 months (range 7–34 months). According to Vancouver classification, 7, 14, and 3 patients were type B1, B2, and B3 fractures, respectively. Both MIPPO and NCB.PP were employed for fracture reduction and fixation for all patients. All patients were followed up for 18 months continuously. The operation duration, intraoperative blood loss, number of bicortical screws at the proximal end of the fracture, postoperative complications, fracture healing rate, and time of fractures were recorded for all the patients. The clinical efficacy was assessed using the Harris Hip Score.
Results: The average operation duration was 83.33 ± 12.16 min (range 60–150 min), the average intraoperative blood loss was 448.14 ± 186.24 mL (range 300–750 mL), and the average number of bicortical screws at the proximal end of the fracture was 3.62 ± 0.57 (range 3 ± 5). The fracture healing rate was 91.67%, and the average healing time was 7.83 ± 1.24 months (6–18 months). The average Harris Hip Score in the last follow-up was 73.75 ± 12.62 (range 45 ± 95). No cases of reduction loss, internal fixation failure, prosthesis dislocation, or renovation were reported. Two cases of superficial wound infection, three cases of postoperative pulmonary infection, and three cases of postoperative urinary tract infectionwere successfully treated with targeted interventions.
Conclusion: MIPPO combined with NCB.PP for treating Vancouver type B femoral periprosthetic fractures can shorten the operation duration, reduce intraoperative blood loss, alleviate iatrogenic surgical trauma, provide sufficient internal fixation strength, facilitate fracture healing, and stabilize the prosthesis effectively, and can be recommended for clinical use.
| [1] |
Z. Jin, L. Wang, J. Qin, H. Hu, and Q. Wei, “Direct Anterior Approach Versus Posterolateral Approach for Total Hip Arthroplasty in the Treatment of Femoral Neck Fractures in Elderly Patients: A Meta-Analysis and Systematic Review,” Annals of Medicine 55, no. 1 (2023): 1378–1392, https://doi.org/10.1080/07853890.2023.2193424.
|
| [2] |
M. Tohidi, S. M. Mann, M. A. McIsaac, and P. A. Groome, “Comparative Effectiveness of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fracture: A Propensity-Score-Matched Cohort Study,” Journal of Bone and Joint Surgery 105, no. 8 (2023): 591–599, https://doi.org/10.2106/JBJS.22.01193.
|
| [3] |
D. Szymski, N. Walter, P. Krull, et al., “Comparison of Mortality Rate and Septic and Aseptic Revisions in Total Hip Arthroplasties for Osteoarthritis and Femoral Neck Fracture: An Analysis of the German Arthroplasty Registry,” Journal of Orthopaedics and Traumatology 24, no. 1 (2023): 29, https://doi.org/10.1186/s10195-023-00711-9.
|
| [4] |
G. Caruso, L. Milani, T. Marko, V. Lorusso, M. Andreotti, and L. Massari, “Surgical Treatment of Periprosthetic Femoral Fractures: A Retrospective Study With Functional and Radiological Outcomes From 2010 to 2016,” European Journal of Orthopaedic Surgery and Traumatology 28, no. 5 (2018): 931–938, https://doi.org/10.1007/s00590-017-2082-x.
|
| [5] |
G. R. Toci, J. B. Stambough, J. R. Martin, et al., “Effect of Fracture Type, Treatment, and Surgeon Training on Reoperation After Vancouver B Periprosthetic Femur Fractures,” Journal of Arthroplasty 38, no. 9 (2023): 1864–1868, https://doi.org/10.1016/j.arth.2023.03.024.
|
| [6] |
M. F. R. Powell-Bowns, E. Oag, D. Martin, N. D. Clement, and C. E. H. Scott, “Vancouver B and C Periprosthetic Fractures Around the Cemented Exeter Stem: Sex Is Associate With Fracture Pattern,” Archives of Orthopaedic and Trauma Surgery 142, no. 11 (2022): 3221–3228, https://doi.org/10.1007/s00402-021-04113-6.
|
| [7] |
Y. P. Weng, Z. J. Yu, R. B. Sun, N. W. Xu, and Y. Zhang, “Treatment of Femoral Periprosthetic Fracture of Vancouver Type B1 and C With Bridge Combined Internal Fixation System,” Zhongguo Gu Shang 33, no. 4 (2020): 371–375, https://doi.org/10.12200/j.issn.1003-0034.2020.04.016.
|
| [8] |
M. F. Hoffmann, S. Lotzien, and T. A. Schildhauer, “Outcome of Periprosthetic Femoral Fractures Following Total Hip Replacement Treated With Polyaxial Locking Plate,” European Journal of Orthopaedic Surgery and Traumatology 27, no. 1 (2017): 107–112, https://doi.org/10.1007/s00590-016-1851-2.
|
| [9] |
M. Moazen, J. H. Mak, L. W. Etchels, et al., “Periprosthetic Femoral Fracture—A Biomechanical Comparison Between Vancouver Type B1 and B2 Fixation Methods,” Journal of Arthroplasty 29, no. 3 (2014): 495–500, https://doi.org/10.1016/j.arth.2013.08.010.
|
| [10] |
J. T. Griffiths, A. Taheri, R. E. Day, and P. J. Yates, “Better Axial Stiffness of a Bicortical Screw Construct Compared to a Cable Construct for Comminuted Vancouver B1 Proximal Femoral Fractures,” Journal of Arthroplasty 30, no. 12 (2015): 2333–2337, https://doi.org/10.1016/j.arth.2015.06.060.
|
| [11] |
J. Joestl, M. Hofbauer, N. Lang, T. Tiefenboeck, and S. Hajdu, “Locking Compression Plateversus Revision Prosthesis for Vancouver Type B2 Periprosthetic Femoral Fractures After Total Hip Arthroplasty,” Injury 47, no. 4 (2016): 939–943, https://doi.org/10.1016/j.injury.2016.01.036.
|
| [12] |
K. Stoffel, M. Blauth, A. Joeris, A. Blumenthal, and E. Rometsch, “Fracture Fixation Versus Revision Arthroplasty in Vancouver Type B2 and B3 Periprosthetic Femoral Fractures: A Systematic Review,” Archives of Orthopaedic and Trauma Surgery 140, no. 10 (2020): 1381–1394, https://doi.org/10.1007/s00402-020-03332-7.
|
| [13] |
R. Langenhan, P. Trobisch, P. Ricart, and A. Probst, “Aggressive Surgical Treatment of Periprosthetic Femur Fractures Can Reduce Mortality: Comparison of Open Reduction and Internal Fixation Versus a Modular Prosthesis Nail,” Journal of Orthopaedic Trauma 26, no. 2 (2012): 80–85, https://doi.org/10.1097/BOT.0b013e31821d6f55.
|
| [14] |
C. Quah, M. Porteous, and A. Stephen, “Principles of Managing Vancouver Type B Periprosthetic Fractures Around Cemented Polished Tapered Femoral Stems,” European Journal of Orthopaedic Surgery and Traumatology 27, no. 4 (2017): 477–482, https://doi.org/10.1007/s00590-016-1883-7.
|
| [15] |
H. Malchau, P. Herberts, T. Eisler, G. Ö. R. A. N. Garellick, and P. E. T. E. R. Söderman, “The Swedish Total Hip Replacement Register,” Journal of Bone and Joint Surgery. American Volume 2 (2002): 2–20, https://doi.org/10.2106/00004623-200200002-00002.
|
| [16] |
F. Francony, E. Montbarbon, R. Pailhé, B. Rubens Duval, and D. Saragaglia, “Assessment of Morbidity and Mortality After Periprosthetic Hip Fracture. Influence of Vancouver Stage in a Retrospective Single-Centre Study of 88 Patients,” Rthopaedics & Traumatology: Surgery & Research 108, no. 1 (2022): 102985, https://doi.org/10.1016/j.otsr.2021.102985.
|
| [17] |
S. H. Oh, Y. S. Suh, E. Eghan-Acquah, et al., “Unstable Vancouver B1 Periprosthetic Femoral Fracture Fixation: A Biomechanical Comparison Between a Novel C-Shaped Memory Alloy Implant and Cerclage Wiring,” Journal of International Medical Research 52, no. 3 (2024): 3000605241240946, https://doi.org/10.1177/03000605241240946.
|
| [18] |
R. E. Moore, K. Baldwin, M. S. Austin, and S. Mehta, “A Systematic Review of Open Reduction and Internal Fixation of Periprosthetic Femur Fractures With or Without Allograft Strut, Cerclage, and Locked Plates,” Journal of Arthroplasty 29, no. 5 (2014): 872–876, https://doi.org/10.1016/j.arth.2012.12.010.
|
| [19] |
V. Ciriello, R. Chiarpenello, A. Tomarchio, F. Marra, A. C. Egidio, and L. Piovani, “The Management of Vancouver B1 and C Periprosthetic Fractures: Radiographic and Clinic Outcomes of a Monocentric Consecutive Series,” Hip International 30, no. 2_suppl (2020): 94–100, https://doi.org/10.1177/1120700020971727.
|
| [20] |
V. Pavone, C. de Cristo, A. Di Stefano, et al., “Periprosthetic Femoral Fractures After Total Hip Arthroplasty: An Algorithm of Treatment,” Injury 50, no. 2 (2019): S45–S51, https://doi.org/10.1016/j.injury.2019.01.044.
|
| [21] |
G. Chatziagorou, H. Lindahl, and J. Kärrholm, “Surgical Treatment of Vancouver Type B Periprosthetic Femoral Fractures: Patient Characteristics and Outcomes of 1381 Fractures Treated in Sweden Between 2001 and 2011,” Bone & Joint Journal 101-B, no. 11 (2019): 1447–1458, https://doi.org/10.1302/0301-620x.101b11.Bjj-2019-0480.R2.
|
| [22] |
D. Chakrabarti, N. Thokur, and S. Ajnin, “Cable Plate Fixation for Vancouver Type-B1 Periprosthetic Femoral Fractures-Our Experience and Identification of a Subset at Risk of Non-Union,” Injury 50, no. 12 (2019): 2301–2305, https://doi.org/10.1016/j.injury.2019.10.012.
|
| [23] |
D. P. Lewis, S. M. Tarrant, L. Cornford, and Z. J. Balogh, “Management of Vancouver B2 Periprosthetic Femoral Fractures, Revision Total Hip Arthroplasty Versus Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis,” Journal of Orthopaedic Trauma 36, no. 1 (2022): 7–16, https://doi.org/10.1097/BOT.0000000000002148.
|
| [24] |
L. Froberg, A. Troelsen, and M. Brix, “Periprosthetic Vancouver Type B1 and C Fractures Treated by Locking-Plate Osteosynthesis: Fracture Union and Reoperations in 60 Consecutive Fractures,” Acta Orthopaedica 83, no. 6 (2012): 648–652, https://doi.org/10.3109/17453674.2012.747925.
|
| [25] |
H. Xue, Y. Tu, M. Cai, and A. Yang, “Locking Compression Plate and Cerclage Band for Type B1 Periprosthetic Femoral Fractures Preliminary Results at Average 30-Month Follow Up,” Journal of Arthroplasty 26, no. 3 (2011): 467–471, https://doi.org/10.1016/j.arth.2010.03.031.
|
| [26] |
G. S. Lewis, C. T. Caroom, H. Wee, et al., “Tangential Bicortical Locked Fixation Improves Stability in Vancouver B1 Periprosthetic Femur Fractures: A Biomechanical Study,” Journal of Orthopaedic Trauma 29, no. 10 (2015): 364–370, https://doi.org/10.1097/bot.0000000000000365.
|
| [27] |
S. Boesmueller, S. F. Baumbach, M. Hofbauer, and G. E. Wozasek, “Plate Failure Following Plate Osteosynthesis in Periprosthetic Femoral Fractures,” Wiener Klinische Wochenschrift 127, no. 19–20 (2015): 770–778, https://doi.org/10.1007/s00508-015-0818-3.
|
| [28] |
C. Gwinner, S. Märdian, T. Dröge, M. Schulze, M. J. Raschke, and R. Stange, “Bicortical Screw Fixation Provides Superior Biomechanical Stability but Devastating Failure Modes in Periprosthetic Femur Fracture Care Using Locking Plates,” International Orthopaedics 39, no. 9 (2015): 1749–1755, https://doi.org/10.1007/s00264-015-2787-6.
|
| [29] |
L. B. Solomon, S. M. Hussenbocus, T. A. Carbone, S. A. Callary, and D. W. Howie, “Is Internal Fixation Alone Advantageous in Selected B2 Periprosthetic Fractures?,” ANZ Journal of Surgery 85, no. 3 (2015): 169–173.
|
| [30] |
A. Castelli, S. M. P. Rossi, L. Rocca, et al., “Treatment of Vancouver B1, C Periprosthetic Hip Fractures With Periprosthetic Polyaxial Locking Plate System: A 3-Year Follow-Up,” Journal of Biological Regulators & Homeostatic Agents 32, no. 1 (2018): 209–216.
|
| [31] |
D. Tigani, E. Ferranti Calderoni, G. Melucci, et al., “Treatment of Periprosthetic Hip Fractures Vancouver B1 and C: The Significance of Bicortical Fixation. A Bicentric Study Comparing Two Osteosynthesis Systems,” Orthopedic Reviews (Pavia) 16 (2024): 117203, https://doi.org/10.52965/001c.117203.
|
| [32] |
A. Frank, M. D. Liporace, S. Richard, et al., “Interprosthetic and Peri-Implant Fractures: Principles of Operative Fixation and Future Directions,” Journal of Orthopaedic Trauma 31, no. 5 (2017): 287–292, https://doi.org/10.1097/bot.0000000000000784.
|
| [33] |
B. W. Min, C. H. Cho, E. S. Son, K. J. Lee, S. W. Lee, and K. K. Min, “Minimally Invasive Plate Osteosynthesis With Locking Compression Plate in Patients With Vancouver Type B1 Periprosthetic Femoral Fractures,” Injury 49, no. 7 (2018): 1336–1340, https://doi.org/10.1016/j.injury.2018.05.020.
|
| [34] |
Y. G. Park, H. Kang, J. K. Song, J. Lee, J. Y. Rho, and S. Choi, “Minimally Invasive Plate Osteosynthesis With Dual Plating for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty,” Journal of Orthopaedic Surgery and Research 16, no. 1 (2021): 433, https://doi.org/10.1186/s13018-021-02586-0.
|
| [35] |
M. T. Kennedy, A. Mitra, T. G. Hierlihy, J. A. Harty, D. Reidy, and M. Dolan, “Subtrochanteric Hip Fractures Treated With Cerclage Cables and Long Cephalomedullary Nails: A Review of 17 Consecutive Cases Over 2 Years,” Injury 42, no. 11 (2011): 1317–1321, https://doi.org/10.1016/j.injury.2011.03.023.
|
RIGHTS & PERMISSIONS
2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
