1. Michael Brix Odense University Hospital Denmark Periprosthetic Femoral Fractures Around Well-Fixed Total Hip Artroplasties Results After Osteosynthesis

2. Introduction Traditionally periprostetic fractures around the THA with well-fixed stems has been operated by traumatologist The MIPO tecnique and the use of locked plates has been favored at our institution Treatment has been according to the Vancouver algorithm

3. Materiale and methods Postoperative Periprosthetic femoral fractures operated at Odense University Hospital from May 2002-October 2010 All treated by osteosynthesis 64 consecutive ptt (67 fractures) were included. Median age was 80 years (range, 49-97 years) 15 men and 49 woman

4. Materiale and methods Prosthesis: 58 THA (10 had both THA and TKA in the same leg) 9 hemiartroplasties Vancouver classification: 26 B1 fractures 1 B2 fracture (misunderstood) 40 C fractures

5. Indication

6. Materiale and methods Approach 57 MIPO (minimal invasive plate osteosynthesis) 10 ORIF (open reduction internal fixation) Implants 55 LISS plates 10 LCP plates 1 Dall Miles Plate 1 Retrograde nail All operations but two were done by a Traumatologist

7. Results – follow up whole group: 26 months (range, 0-99) Patients alive: 39 months (range, 1-99) Patients diseased: 14 months (range, 0-56) 33/64 (51%) diseased until now. 23/64 (36%) diseased within the first year after surgery

8. Results - union Of the 67 fractures 11 diseased 0-6 months post operative 2 were operated less than 2 months ago 4 radiographs were missing The remaing 50/50 (100%) fractures had union

9. Results - Reoperation Failure of fixation N=7 (10%) Reoperation N=10/67(15%) Deep infection N=2(2,9%) Loose prosthesis N=1(1,5%) Revision prosthesis N=4 Longer plate N=2 Revision surgery N=2 Revision prosthesis N=1 Plate removal N=1

10. 4 reoperations due to new fall had a revisionprosthesis, because of loose stem. (stressrisers?)

11. 2 reoperations due to new fracture, stressrisers?? (spanning the prosthesis) they both had a longere plate

12. Results compared to litterature Many case series with 4-39 cases of periprosthetic fractures Vancouver type B1 and C is reported over years, failure rates from o-50. Evidens level IV 2 comphrensive articles with review and guidelines Injury. 2007 Jun;38(6):669-87. Epub 2007 Apr 30. Principles of internal fixation and selection of implants for periprosthetic femoral fractures. Giannoudis PV, Kanakaris NK, Tsiridis E. Giannoudis PVKanakaris NKTsiridis E Department of Trauma & Orthopaedic Surgery, Academic Unit, School of Medicine, University of Leeds, J Am Acad Orthop Surg. 2009 Nov;17(11):677-88. Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. Pike J, Davidson D, Garbuz D, Duncan CP, O'Brien PJ, Masri BA. Pike JDavidson DGarbuz DDuncan CPO'Brien PJMasri BA

13. Conclusion Make Vancouver type classification on plain radiographs Use the Vancouver treatment algorithm for periprosthetic fractures Stick with basic osteosynthesis principles Avoid stress rising area Locked plate osteosynthesis and MIPO technique can give good results with a high union rate and a low reoperations rate

14. Revers LISS Plate LAP device (optional) Cables (optional) Interfragmentary compression Screw And spanning the whole prosthesis Our current concept