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Thursday, October 7, 2010, 16:30-17:20Session A8: Periprosthetic Fractures in THAFixation Methods in the Treatment of Vancouver B1 Periprosthetic HipFractures: Our Experience of 69 Cases*Jonathan Phillips - Queen's Medical Centre, Nottingham University Hospitals - Nottingham,UKChris Boulton - Queen's Medical Centre, Nottingham - Nottingham, UKChris Moran - Queen's Medical Centre, Nottingham - Nottingham, UKAndrew Manktelow - Queen's Medical Centre, Nottingham - Nottingham, UK*Email: jonphillips99@hotmail.comWe have identified 69 patients with Vancouver B1 periprosthetic fractures around stablefemoral implants. Open reduction internal fixation is the recommended treatment; howeverrecent studies have revealed high rates of nonunion. We have reviewed the fixation techniquesutilized to treat these patients, and identified outcomes in relation to rates of union, furthersurgery and mortality.Patients were identified from a prospective database of all trauma admissions at NottinghamUniversity Hospitals from 1999 to 2010. Hospital notes were independently reviewed and dataretrieved.69 patients were identified. Mean age 77 years and 63% were female. 51 (74%) occurredaround total hip replacements and 18 (26%) around hip hemiarthroplasty after a previous hipfracture.Periprosthetic fracture occurred around an Exeter stem (n=18), Charnley (n=10), Austin Moore(n=15), other (n=6). 20 patients had undergone previous revision surgery. The mean time fromindex surgery to fracture was 58 months (median 24) around primary stems, and 48 months(median 22) around revision stems.6 patients (9%) were treated non-operatively. Five of these had undisplaced fractures (all healedbut one required revision due to loosening) and one was too unwell.63 patients (91%) were treated by open reduction internal fixation. Of these, single platefixation was performed in 40 cases (64%). In the vast majority of cases, lag screw fixation ofthe fracture with a long (>12 hole) pre-contoured 4.5mm locking plate was utilised with cables.Both locking and cortical screws were used to achieve stable fixation (Figure 1). A double platetechnique was used in 16 cases (25%), where plates were placed perpendicularly to each other(laterally and anteriorly). Strut grafts were used in 13 cases (21%). 7 patients (11%) weretreated with cables alone.23 patients have subsequently died (33%). Two have been lost to follow up and three areawaiting union. There is a mean follow-up of 35 months.Deep infection occurred in 4 cases (6%). Non-union occurred in four cases (6%). Two of thesewere infected and one was treated with cables alone. Malunion occurred in one case treatedwith cables. One patient had a dislocation and two superficial infections occurred.Further surgery took place in 8 patients (12%). Three of the infected cases were revised and oneunderwent wound washout. The two other non-unions were revised. Three further revisionswere performed: one for malunion, one for aseptic loosening (treated non-operatively) andanother for a second periprosthetic fracture. Superficial wound washout was performed in onecase.file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]