Two plates better than one in preventing periprosthetic fracture

MADRID — There is a “distinct advantage” in using two plates of uneven lengths to improve the chances of healing and prevent implant failure and periprosthetic fracture, according to a physician here.

Bhushan Sabnis, an orthopaedic physician from the United Kingdom, reported his findings at the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congress 2010.

Sabnis also noted that using two plates could reduce the stress riser effect, and advocated primary fixation of periprosthetic fractures of the proximal femur — using two Dall-Miles cable plates (Stryker) and a bone graft — over total hip replacement (THR).

“We all know that periprosthetic fractures are on the rise because the population is getting older,” Sabnis said.

“We feel that a single plate/cable construct is not sufficiently strong to support a bone in an active patient,” he added.

Plate fixation versus total hip replacement

Sabnis and his group investigated 19 patients who underwent the cable plate fixation for periprosthetic fracture instead of a hemiarthroplasty or a total hip replacement during the past 5 years. Their clinical and radiologic outcome measures were recorded.

The patients had an average age of 77.33 years. Eight had their periprosthetic fracture after hemiarthroplasty, Sabnis reported, while 11 had it after total hip replacement. According to Sabnis, the two groups were “completely different” in terms of fitness, activities and expectations.

Sabnis said 12 of the patients were type B1, while seven were Vancouver C. Five were initially managed with two plates, with the remainder using only one. Follow-up was conducted at an average of 3.1 years.

Three patients had died of unrelated medical problems before follow-up. One had a deep infection that required revision and one had superficial infection healed through antibiotics.

Two plates show promise

Sabnis reported that as a result of hip pain, one patient underwent revision to a THR. Of those managed with a single plate, three patients suffered failure of the cable or plate and thus underwent revision plating with two plates and allogenic bone grafting. All of these cases, Sabnis said, healed well.

Meanwhile, the five patients managed initially with two plates healed fully without any complications.

Sabnis noted that the study series was small, but said it was “evident” that Dall Miles plating with a single plate has a high incidence — three of 13 in this study alone — of failure.

Reference:
Sabnis B, Ahmed I, Chesney D. Results o Dall Miles cable plate fixation for periprosthetic fractures of femur: Are two plates better than one? Paper F630. Presented at the EFORT Congress 2010. June 2-5, 2010. Madrid.