CABLE PLATE FIXATION – AN ATTRACTIVE OPTION FOR THE FIXATION OF PERIPROSTHETIC FRACTURE WITH INTACT STEM

Abstract

There are many management solutions for the fixation of Periprosthetic fractures with intact stem of Hip and shoulder arthroplasties. The Bio Mechanics of single plate application are unlikely to be strong enough to commence mobilisation and its effectiveness against torsional strain with an osteoporotic bone quality is of concern. Double plate fixation as discussed at the last South African Orthopaedic Congress by Mr Floyd et al is another option but this again may have some biomechanical concerns and biological compromise at the fracture site due to periosteal stripping. Implant revision with a longer stem is a bigger surgical insult to a potentially frail group of patients with questionable bone quality. We report a short series of 16 peri-prosthetic fractures with intact stem that are managed with Zimmer cable plate fixation System. The results were very satisfactory and we consider this an attractive option to be considered in the management of this difficult presentation.

This is a retrospective study. We present the results of 13 Periprosthetic Femoral Shaft fractures and 3 humeral periprosthetic fractures in 16 patients treated with cable plate fixation system. Majority of the patients were over 60 years with an ASA rating of 3–4. The procedures were performed in a district general hospital in the UK between August 2001 to December 2005. The patients presented with in 1–20 years following initial Arthroplasty. All the fractures were fixed with Zimmer cable plate fixation system. An 8 hole plate was most commonly used for femoral fractures through the lateral approach for TYPE 2 fractures. The proximal end of the plate was secured with 3–4 cable ties. Early partial weight bearing was encouraged.

The majority of the patients were discharged within 12 weeks. Of the 3 humeral fractures union was achieved at 12 weeks in 2. There was 1 case of implant failure due to a further fracture noted in a manic depressive patient, who was not compliant. All proximal femoral fractures showed evidence of clinical and radiological union by 6 months. The majority (7/13) had united within 20 weeks. There were no complications noted. We recommend this effective method should seriously be considered in the management of this difficult and increasingly occurring complication in a frail population.