University of Pisa, Via Paradisa 2, Pisa, IT.
University of Pisa, Via Paradisa 2, Pisa, IT.
Injury. 2021 Aug;52(8):2459-2462. doi: 10.1016/j.injury.2021.02.089. Epub 2021 Mar 2.
Periprosthetic femoral fractures (PFF) actually represent a serious public health problem. They are reported to occur in 0,1-4.5% of all patients undergoing total hip replacement (THR). PFF are commonly distinguished using the Vancouver classification. This study principal aim is to evaluate results obtained using the Intrauma Iron Lady® Conical Coupling locking plate for the treatment of Vancouver type B1 periprosthetic femoral fractures.
We enrolled 32 patients affected by Vancouver B1 PFF and treated with the same device. Metal cerclages were additionally used in 12 (38%) patients. A clinical and radiographical post-operative follow-up was then planned at 1, 3 and 6 months after surgery; than the follow-up was annually fixed.
Mean age at the moment of trauma was 76,7 years. All involved femoral stem were uncemented and the they were all radiographically and intraoperativelly judged to be stable. Mean post-operative follow-up period was 5,8 years. 29 patients (91%) presented healed fracture at 6 months follow-up. 9% patients developed a superficial surgical site infection.
Literature highlights that Vancouver B1 PFF should be treated with open reduction and internal fixation (ORIF) using polyaxial locking plates. However, no single technique has gained universal acceptance to be superior that the other. The current reported healing rate ranges from 40 to 100%. Using the Intrauma Iron Lady® Conical Coupling locking plate, we obtained a healing rate of 91%; this data is consistent with recent literature. Moreover, the role of cerclages in addition to femoral plating is actually controversial because they potentially damage the soft callus vascularization. Our results showed no difference in term of healing rate between patients with and without cerclages, according with some of most recent articles. A prospective study with a higher number of patients should be carried out in order to better evaluate the role of cerclages on healing rate but also the complications frequency after PFF surgical treatment.
股骨假体周围骨折（PFF）实际上是一个严重的公共卫生问题。据报道，在所有接受全髋关节置换术（THR）的患者中，其发生率为 0.1-4.5%。PFF 通常使用温哥华分类法进行区分。本研究的主要目的是评估使用 Intrauma Iron Lady®锥形连接锁定板治疗温哥华 B1 型股骨假体周围骨折的结果。
我们纳入了 32 例温哥华 B1 型 PFF 患者，并使用相同的装置进行治疗。12 例（38%）患者还使用了金属环扎。然后，计划在手术后 1、3 和 6 个月进行临床和影像学随访，之后每年进行一次固定随访。
创伤时的平均年龄为 76.7 岁。所有涉及的股骨柄均为非骨水泥固定，且均在影像学和术中被判断为稳定。平均术后随访时间为 5.8 年。29 例（91%）患者在 6 个月随访时骨折愈合。9%的患者发生浅表手术部位感染。
文献强调，温哥华 B1 型 PFF 应采用多轴锁定钢板进行切开复位内固定（ORIF）治疗。然而，尚无单一技术被普遍认为优于其他技术。目前报道的愈合率为 40%至 100%。使用 Intrauma Iron Lady®锥形连接锁定板，我们获得了 91%的愈合率；这一数据与最近的文献一致。此外，钢丝环扎在股骨钢板固定之外的作用实际上存在争议，因为它们可能会破坏软愈合力的血管化。我们的结果显示，钢丝环扎患者与无钢丝环扎患者的愈合率无差异，这与最近的一些文章一致。为了更好地评估钢丝环扎对愈合率的作用以及 PFF 手术后并发症的发生率，应该进行一项具有更高患者数量的前瞻性研究。
