Locking Attachment Plate for the Surgical Treatment of Periprosthetic and Periimplant Fractures: Long-Term Follow-Up

Document Type : RESEARCH PAPER

Authors

Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain

10.22038/abjs.2023.72299.3367

Abstract

Objectives: The surgical management of periprosthetic fractures (PPF) and periimplant fractures (PIF) 
can be challenging. The locking attachment plate (LAP) was proposed in recent years for the 
osteosynthesis of such fractures. The aim of this study was to assess the experience of a third -level 
hospital with LAP for the treatment of PPF and PIF, and analyse the clinical outcomes.
Methods: Data were prospectively collected and analysed from all patients whose PPF/PIF was treated surgically 
with LAP in a third-level hospital from June 2018 to June 2022. All fractures were postoperative low-energy femur 
fractures. The minimum follow-up period was six months.
Results: Thirty-eight patients (31 women) met the eligibility criteria. The mean age was 86.3 years. The median 
time until surgery was 4 days. A mean of 3.61 screws were used for each LAP. The mean femur plate length was 
14 holes, and the mean working length 7.1 holes. The median hospital stay was nine days. The mean follow-up was 
19.56 months. At one month, 12 patients tolerated partial weight-bearing. Five patients walked independently 
indoors. One patient had died and seven patients were readmitted. At six months, six more patients had died. Fifteen 
patients tolerated full weight-bearing (FWB). Nine patients walked independently indoors, six outdoors. Twenty-five 
patients reached fracture consolidation without malalignment. Nine patients were readmitted. At 12 months, another 
patient had died. Seventeen patients tolerated FWB. Eleven patients walked independently indoors, six outdoors. 
Twenty-five patients achieved fracture consolidation without malalignment. Five patients were readmitted. Fourteen 
patients crossed the two-year postoperative threshold. All achieved fracture consolidation. Two patients passed the 
4-year postoperative milestone.
Conclusion: The clinical results of patients whose PPF or PIF was treated with the LAP are promising. This fixation 
method is a viable option to be considered when planning surgery for such fractures.
 Level of evidence: III

Keywords

Main Subjects

References

  1. Della Rocca GJ, Leung KS, Pape HC. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma. 2011; 25 (Suppl 2):S66-S70. doi:10.1097/BOT.0b013e31821b8c28.
  2. Bottle A, Griffiths R, White S, et al. Periprosthetic fractures: The next fragility fracture epidemic? A national observational study. BMJ Open. 2020; 10(12):e042371. doi:10.1136/bmjopen-2020-042371.
  3. Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic

 

femoral fractures: Classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty. 2005; 20(7):857-865. doi:10.1016/j.arth.2005.02.001.

  1. Rollo G, Bonura EM, Huri G, et al. Standard plating vs. cortical strut and plating for periprosthetic knee fractures: a multicentre experience. Med Glas (Zenica). 2020; 17(1):170-177. doi: 10.17392/1035-20.
  2. Halonen LM, Stenroos A, Vasara H, Kosola J. Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture. Arch Orthop Trauma Surg. 2022; 142(12):3715-3720. doi:10.1007/s00402-021-04193-4.
  3. Abdel MP, Watts CD, Houdek MT, Lewallen DG, Berry DJ. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: A 40-year experience. Bone Joint J. 2016; 98B (4):461-467. doi:10.1302/0301-620X.98B4.37201.
  4. Adolphson P, Jonsson U, Kalén R. Fractures of the ipsilateral femur after total hip arthroplasty. Arch Orthop Trauma Surg (1978). 1987; 106(6):353-357. doi:10.1007/BF00456869.
  5. Marsland D, Mears SC. A Review of Periprosthetic Femoral Fractures Associated With Total Hip Arthroplasty. Geriatr Orthop Surg Rehabil. 2012; 3(3):107-120. doi:10.1177/2151458512462870.
  6. Zheng H, Gu H, Shao H, Huang Y, Yang D, Tang H, et al. Treatment and outcomes of Vancouver type B periprosthetic femoral fractures. Bone Joint J. 2020; 102(3):293-300. doi:10.1302/0301-620X.102B3.BJJ-2019-0935.R1.
  7. Roche-Albero A, Mateo-Agudo J, Martín-Hernández C, Arnaudas-Casanueva M, Gil-Albarova J. Osteosynthesis in Vancouver type B1 periprosthetic fractures. Injury. 2021; 52(8):2451-2458. doi:10.1016/j.injury.2021.03.023.
  8. Lewis DP, Tarrant SM, Cornford L, Balogh ZJ. Management of Vancouver B2 Periprosthetic Femoral Fractures, Revision Total Hip Arthroplasty versus Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis. J Orthop Trauma. 2022; 36(1):7-16. doi:10.1097/BOT.0000000000002148.
  9. Ragland K, Reif R, Karim S, et al. Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation versus Revision. Geriatr Orthop Surg Rehabil. 2020; 11:2151459320939550. doi:10.1177/2151459320939550.
  10. Phillips JRA, Boulton C, Moran CG, Manktelow ARJ. What is the financial cost of treating periprosthetic hip fractures? Injury. 2011; 42(2):146-149. doi:10.1016/j.injury.2010.06.003.
  11. Matassi F, Angeloni R, Carulli C, et al. Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus. Injury. 2012; 43(11):1939-1942. doi: 10.1016/j.injury.2012.08.004.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 4
April 2024
Pages 256-263

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History

  • Receive Date: 17 May 2023
  • Revise Date: 20 December 2023
  • Accept Date: 24 December 2023

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