The use of locking plates for greater trochanteric fixation

Application of a Fork Plate for Greater Trochanter Osteosynthesis in Total Hip Arthroplasty

The aim of the study was to assess the effectiveness of using an original technique of greater trochanter fragment fixation during total hip replacement.

Use of locking plates for fixation of the greater trochanter in patients with hip replacement

BACKGROUND

Fixation of the greater trochanter with total hip replacement is challenging and associated with short- and long-term complications. Locking plate technology has been used for fixation of other bones and may be applied successfully in trochanteric fixation. The purpose of this retrospective study was to analyze the utility of the use of trochanteric locking plates in total hip arthroplasty (THA) patients.

METHODS

From 2004 to 2014, 32 procedures were performed to fix the greater trochanter in patients with trochanteric fracture, osteotomy, or nonunion in the setting of THA. The median age at the time of surgery was 69 years. This was a primary arthroplasty in 8 of the patients, conversion from prior hip surgery in 5, and a revision in 19. The greater trochanter was fixed with locking plate alone in 15 hips and with the addition of a single cerclage cable in 17 hips. Patients were followed clinically and radiographically until healing occurred. The median duration of radiographic follow-up was 41.6 months (range: 10-112 months).

RESULTS

Osseous union occurred in 29 (90.6%) of 32 hips. The median Harris hip score was 94 (range 54-100, standard deviation = 10.4) at latest follow-up. Complications included broken hardware in 5 (15.6%) patients, of which 3 underwent subsequent hardware removal. Two additional patients elected hardware removal due to trochanteric pain.

CONCLUSIONS

Locking plate technology is a successful method of fixation of the greater trochanter in patients with THA. Postoperative trochanteric pain and reoperation for hardware-related issues remain a challenge.

Use of auxiliary locking plates for the treatment of unstable pertrochanteric femur fractures

Pertrochanteric femur fractures are successfully treated by orthopedic surgeons worldwide, but maintaining the reduction status or fixation of the greater trochanter is sometimes difficult in unstable cases in elderly patients. Several biomechanical advantages have been reported in locking plates when compared with conventional plates; locking plates provide angular and axial stability, better rigidity, and no toggling, and they preserve periosteal blood supply. The authors describe the use of auxiliary locking plates in unstable pertrochanteric femur fractures in elderly patients. Mini locking plates are simple, straightforward, and versatile enough to be used in elderly patients.

A review of periprosthetic femoral fractures associated with total hip arthroplasty

Periprosthetic fractures of the femur in association with total hip arthroplasty are increasingly common and often difficult to treat. Patients with periprosthetic fractures are typically elderly and frail and have osteoporosis. No clear consensus exists regarding the optimal management strategy because there is limited high-quality research. The Vancouver classification facilitates treatment decisions. In the presence of a stable prosthesis (type-B1 and -C fractures), most authors recommend surgical stabilization of the fracture with plates, strut grafts, or a combination thereof. In up to 20% of apparent Vancouver type-B1 fractures, the femoral stem is loose, which may explain the high failure rates associated with open reduction and internal fixation. Some authors recommend routine opening and dislocation of the hip to perform an intraoperative stem stability test to rule out a loose component. Advances in plating techniques and technology are improving the outcomes for these fractures. For fractures around a loose femoral prosthesis (types B2 and 3), revision using an extensively porous-coated uncemented long stem, with or without additional fracture fixation, appears to offer the most reliable outcome. Cement-in-cement revision using a long-stem prosthesis is feasible in elderly patients with a well-fixed cement mantle. It is essential to treat the osteoporosis to help fracture healing and to prevent further fractures. We provide an overview of the causes, classification, and management of periprosthetic femoral fractures around a total hip arthroplasty based on the current best available evidence.

Trochanteric fixation using a third-generation cable device--minimum follow-up of 3 years

Third-generation trochanteric fixation cable systems are designed to overcome implant breakage, nonunion, and bony escape. The study prospectively assessed the functional and radiologic outcomes using such an implant. Forty-seven trochanteric fixations in 46 patients were performed over 4 years at 2 institutions using the Accord Cable Plate system (Smith and Nephew, Memphis, Tenn). Serial evaluation at a mean follow-up of 57 months demonstrated that the mean Harris hip scores improved from 52.3 preoperatively to 88.2 postoperatively (P < .001), and the mean pain score improved from 6.2 to 2.3, respectively (P < .001). No cable breakage, fretting, or fraying occurred. There were 2 cases of nonunion. A third-generation cable system appears to improve upon early-generation implants and provide favorable outcomes for reattachment of a trochanteric fragment in a variety of clinical scenarios.