Gavanier B, Houfani F, Dumoulin Q, Bernard E, Mangin M, Mainard D
Service de chirurgie orthopédique, traumatologique et arthroscopique, CHU Nancy Hôpital Central, 29 avenue de Lattre de Tassigny, 54000 Nancy, France.
Injury. 2017 Dec;48(12):2827-2832. doi: 10.1016/j.injury.2017.10.023. Epub 2017 Oct 10.
Femoral periprosthetic fracture (FPF) is a frequent complication in dependent elderly persons, with a limited life expectancy. Their management is difficult and the choice between osteosynthesis and prosthesis is still matter of discussion. To date, there is no study on unlocked plate with integrated cerclage cable and trochanteric hook for this indication. The objectives of this study were to analyze fracture healing, complication rate and functional outcome. Our hypothesis is that this technique allows a high rate of consolidation and a return to the previous state in terms of autonomy and place of residence.
We conducted a retrospective multicenter study between 2010 and 2015. The inclusion criteria were: patients with type A and B FPF according to the classification of Vancouver who received osteosynthesis hook plate. The evaluation focused on the consolidation period, complications and pre and postoperative Parker and Katz scores. Death, nonunion, dislocation, infection and failure of fixation were considered major complications.
Forty-five patients met the inclusion criteria and were evaluated at mean 20 months (6-72). All fractures consolidated at a mean 7 weeks (6-10), except one that has not undergone further surgery in the absence of functional impairment. Parker score decreased from 6.4 to 4.9 (p=0.03) and Katz score from 4.8 to 4.3 (p=0.045). Five patients died within the year of the operation. Five patients living at home preoperatively were admitted to an institution, the others returned to their retirement home or nursing home.
This plate allows for a quick and effective management of patients with FPF. The low rate of complications and the very good consolidation rate lead us to use the same plate even for class B2 or B3 fractures in some patients with precarious health condition who cannot tolerate major revision surgery: Elderly, ASA score >3, loss of autonomy, Katz score <4.
股骨假体周围骨折（FPF）是预期寿命有限的老年依赖者中的常见并发症。其治疗困难，骨固定术和假体之间的选择仍是讨论的话题。迄今为止，尚无关于用于该适应症的带集成环扎缆线和转子钩的非锁定钢板的研究。本研究的目的是分析骨折愈合情况、并发症发生率和功能结果。我们的假设是，该技术能实现高愈合率，并在自主性和居住地点方面恢复到先前状态。
我们在2010年至2015年间进行了一项回顾性多中心研究。纳入标准为：根据温哥华分类为A型和B型FPF且接受骨固定钩钢板治疗的患者。评估重点为愈合期、并发症以及术前和术后的帕克和卡茨评分。死亡、骨不连、脱位、感染和内固定失败被视为主要并发症。
45例患者符合纳入标准，平均在20个月（6 - 72个月）时接受评估。除1例因无功能障碍未接受进一步手术外，所有骨折均在平均7周（6 - 10周）时愈合。帕克评分从6.4降至4.9（p = 0.03），卡茨评分从4.8降至4.3（p = 0.045）。5例患者在手术年内死亡。术前在家居住的5例患者被送入机构，其他患者返回养老院或疗养院。
该钢板可快速有效地治疗FPF患者。并发症发生率低且愈合率非常好，这使我们即使在一些健康状况不稳定、无法耐受大型翻修手术的患者（老年人、美国麻醉医师协会评分>3、自主性丧失、卡茨评分<4）的B2或B3型骨折中也使用同一钢板。
