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J Am Acad Orthop Surg, Vol 17, No 11, November 2009, 677-688.
© 2009 the American Academy of Orthopaedic Surgeons
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Principles of Treatment for Periprosthetic Femoral Shaft Fractures Around Well-fixed Total Hip Arthroplasty

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

Dr. Pike is Clinical Fellow, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO. Dr. Davidson is Clinical Fellow, Department of Orthopaedic Surgery, Children’s Hospital Boston, Boston, MA. Dr. Garbuz is Associate Professor, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. Dr. Duncan is Professor, Department of Orthopaedics, University of British Columbia. Dr. O’Brien is Associate Professor, Department of Orthopaedics, University of British Columbia. Dr. Masri is Professor, Department of Orthopaedics, University of British Columbia.

Dr. Garbuz or a member of his immediate family has received research or institutional support from Zimmer. Dr. Duncan or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of Zimmer and has received research or institutional support from DePuy, Stryker, and Zimmer. Dr. O’Brien or a member of his immediate family serves as a board member, owner, officer, or committee member of the Canadian Orthopaedic Association and the Orthopaedic Trauma Association and has received research or institutional support from the Canadian Orthopaedic Association, Synthes, and Stryker. Dr. Masri or a member of his immediate family serves as a board member, owner, officer, or committee member of the Canadian Orthopaedic Association and has received research or institutional support from Stryker. Neither of the following authors nor a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Pike and Dr. Davidson.

Reprint requests: Dr. Masri, Department of Orthopaedics, University of British Columbia, 3114-910 West Tenth Avenue, Vancouver, BC, Canada V5Z 4E1.

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.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.