Principles of Treatment for Periprosthetic Femoral Shaft Fractures Around Well-fixed Total Hip Arthroplasty

J Am Acad Orthop Surg, Vol 17, No 11, November 2009,

Jeffrey Pike, MD, Darin Davidson, MD, MHSc, Donald Garbuz, MD, MHSc, FRCSC, Clive P. Duncan, MD, MSc, FRCSC, Peter J. O’Brien, MD, FRCSC and Bassam A. Masri, MD, FRCSC Postoperative periprosthetic femoral fractures around the stem of a total hip arthroplasty are increasing in frequency. To obtain optimal results, full appreciation of the clinical evaluation, classification, and modern management principles and techniques is required. Although periprosthetic femoral fracture associated with a loose stem requires complex revision arthroplasty, fractures associated with a stable femoral stem can be managed effectively with osteosynthesis principles familiar to most orthopaedic surgeons. Femoral fracture around a stable femoral stem is classified as a Vancouver type B1 fracture. The preferred treatment consists of internal fixation, following open or indirect reduction. Emerging techniques, such as percutaneous plating and the use of locking plates, have been used with increasing frequency. Preliminary results of these techniques are promising; however, further prospective comparative studies are required.