Management of Vancouver type B1 periprosthetic femoral shaft fracture by reversed contralateral distal femur locking plate

Abstract

Background:Vancouver B1 periprosthetic femoral fractures are described as fractures occurring around the stem tip in which the prosthesis is stable. Treatment options include Mennen plates (CMW Laboratories, Ex­eter, England), the Dall-Miles plate and cable system (Stryker Howmedica, Ruth­erford, New Jersey), dynamic compression plates, conventional plates, cerclage cables, locking compression plates, and strut allografts with or without plating. The aim of this study was to describe the efficacy of contralateral distal femur locking plate used in reverse for the management of type B1 periprosthetic femur fracture when used in conjunction with intra-operative demonstration of prosthesis stability and correct classification of these fractures. Methods: Total 9 patients with Vancouver Type B1 periprosthetic fractures were enrolled in the study. Average age of all patients was 57.6 years with 8 male and 1 female. All patients were managed by open reduction and internal fixation by reversed contralateral distal femur locking plate and cables/circlage wiring and followed up for a minimum of 12 months. Patients were evaluated both clinically and radiologically. Results: All fractures were united at an average of 14.5 weeks. Harris hip score at final follow-up was 86. One patient had superficial wound infection. The infection was successfully treated by irrigation and debridement of wound and intravenous antibiotics. Conclusion: We observed good functional outcome in patient treated with reversed contralateral distal femur locking plate. We conclude that reversed contralateral distal femur locking plate is a reliable, effective and relatively cheaper option for management of Vancouver B1 periprosthetic femoral shaft fracture.