An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component

J Bone Joint Surg Br. 2009 Nov;91(11):1424-30. doi: 10.1302/0301-620X.91B11.22292.


The use of plate-and-cable constructs to treat periprosthetic fractures around a well-fixed femoral component in total hip replacements has been reported to have high rates of failure. Our aim was to evaluate the results of a surgical treatment algorithm to use these lateral constructs reliably in Vancouver type-B1 and type-C fractures. The joint was dislocated and the stability of the femoral component was meticulously evaluated in 45 type-B1 fractures. This led to the identification of nine (20%) unstable components. The fracture was considered to be suitable for single plate-and-cable fixation by a direct reduction technique if the integrity of the medial cortex could be restored. Union was achieved in 29 of 30 fractures (97%) at a mean of 6.4 months (3 to 30) in 29 type-B1 and five type-C fractures. Three patients developed an infection and one construct failed. Using this algorithm plate-and-cable constructs can be used safely, but indirect reduction with minimal soft-tissue damage could lead to shorter times to union and lower rates of complications.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Arthroplasty, Replacement, Hip
  • Bone Plates
  • Female
  • Femoral Fractures / surgery*
  • Fracture Fixation, Internal / adverse effects
  • Fracture Fixation, Internal / methods*
  • Fracture Healing
  • Hip Joint / physiopathology
  • Hip Prosthesis*
  • Humans
  • Male
  • Middle Aged
  • Recovery of Function
  • Retrospective Studies
  • Treatment Outcome