Fixation of Periprosthetic Femur Fractures Around Total Hip Implants Without the Use of Cables or Struts

Abstract

Fixation of periprosthetic femur fractures around total hip implants without cerclage cables or strut grafts. Periprosthetic fractures around total hip stems are challenging fractures because it is difficult to gain proximal fixation in the area of the femoral stem. The bone is often osteoporotic and locking fixation is preferred over conventional fixation. Most locking plates do not have the ability to angle the screws around the stem and still lock into the plate. Surgeons have resorted to the use of cerclage cables to fix the plate to the bone and allograft cortical struts to improve the strength of the fixation construct. With the advent of polyaxial locking screws and a plate that is wider at the proximal end of the plate, it is now possible to gain bicortical locking fixation around most total hip stems. This eliminates the need for both cables and strut grafts. This paper describes the implants and techniques to accomplish this fixation and stabilize these complex fractures in a more biologically friendly manner.