IS IT NECESSARY TO ALSO USE A STRUCTURAL ALLOGRAFT PLATE WHEN TREATING VANCOUVER TYPE B1 PERIPROSTHETIC FRACTURES?

Abstract

Introduction and Objectives: The treatment of choice in periprosthetic Vancouver B1 fractures is open reduction and fixation with an osteosynthesis plate. There is a certain amount of controversy as to the need to also use a cortical allograft plate.

Materials and Methods: We carried out a revision of periprosthetic fractures Vancouver type B1 treated with Dall-Milles (Styker) plates with and without an additional cortical allograft.

Results: We included a total of 12 patients operated between March 2003 and July 2207, 6 of them had a plate and also an allograft plate (AP) and 6 only had a DM plate alone (DMP). There was one case of superficial infection of the surgical wound in the AP group in the only case of an open fracture (grade 1) in the series. No osteosynthesis failures were seen in either of the groups. Mean age (4 years more), mean hospital stay (4 days more), need for transfusion (33% more) and mortality (16% more) were all greater in the AP group; whereas the size of the DM plate and operation time (30 minutes less) were less. The EQ-5D health scale was one tenth better in the DMP group, but, curiously, the Oxford Hip Score was 9 points lower.

Discussion and Conclusions: Not all patients with periprosthetic fractures Vancouver type B1 treated with a DM plate need the addition of a structural allograft plate. We consider that patients with low bone quality and who were functionally independent before fracture are those that will need a cortical allograft.