Lee Max Liu, Pius Alexa K, Goodnough L Henry
Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States.
Stanford University School of Medicine, Palo Alto, California, United States.
Eur J Orthop Surg Traumatol. 2025 Jul 2;35(1):288. doi: 10.1007/s00590-025-04408-z.
The purpose of the study is to evaluate the safety and efficacy of mini-fragment plate fixation of trochanteric fragments in Vancouver B2 femur fractures. Pre-contoured plates are generally used in the proximal femur of Vancouver B2 fractures to secure trochanteric fragments. However, stout pre-contoured plates are a potential source of symptomatic implants in a sensitive location, and alternatives such as mini-fragment fixation have not yet been reported.
In this case series, we retrospectively reviewed 5 patients who underwent operative treatment of Vancouver B2 periprosthetic femur fractures with locking mini-fragment plate fixation. Demographic and clinical variables were recorded for all patients. Outcome measures including post operative dislocation, infection, mortality, additional procedures, malunion or nonunion, fixation failure, time to ambulation, and instability were recorded and compared to historical alternatives, such as fixation with pre-contoured plates.
No patients experienced fixation failure, nonunion or malunion, or underwent reoperation. One patient died postoperatively due to medical comorbidities. One patient developed mild hip pain around the implant postoperatively with no need for revision.
Mini-fragment plate fixation demonstrated no incidence of fixation failure or nonunion and is safe in the treatment of Vancouver B2 periprosthetic femur fractures. This technique represents a promising alternative in the management of Vancouver B2 periprosthetic femur fractures for surgeons hoping to avoid symptomatic implants without compromising fixation.
本研究旨在评估应用微型接骨板固定温哥华B2型股骨假体周围骨折转子部骨折块的安全性和有效性。预塑形接骨板通常用于温哥华B2型骨折的股骨近端以固定转子部骨折块。然而，坚固的预塑形接骨板在敏感部位是有症状植入物的潜在来源，而诸如微型接骨板固定等替代方法尚未见报道。
在本病例系列中，我们回顾性分析了5例行锁定微型接骨板固定治疗温哥华B2型股骨假体周围骨折的患者。记录所有患者的人口统计学和临床变量。记录包括术后脱位、感染、死亡率、额外手术、畸形愈合或骨不连、固定失败、下地行走时间和不稳定等结局指标，并与历史上的替代方法（如使用预塑形接骨板固定）进行比较。
没有患者出现固定失败、骨不连或畸形愈合，也没有患者接受再次手术。1例患者术后因合并症死亡。1例患者术后在植入物周围出现轻度髋关节疼痛，无需翻修。
微型接骨板固定未出现固定失败或骨不连的情况，在治疗温哥华B2型股骨假体周围骨折方面是安全的。对于希望避免出现有症状植入物且不影响固定效果的外科医生来说，这项技术在温哥华B2型股骨假体周围骨折的治疗中是一种有前景的替代方法。
