Background: The application of indirect reduction techniques has
improved fracture-healing and reduced the need for bone-grafting compared with
the outcomes of older, direct reduction techniques. We investigated the
results of such indirect reduction techniques for the treatment of
periprosthetic femoral shaft fractures.
Methods: Fifty consecutive patients with a femoral shaft fracture
about a stable intramedullary implant (a Vancouver Type-B1 fracture) were
treated with a protocol that included open reduction with use of indirect
reduction techniques and internal fixation with a single lateral plate without
structural allografting or other bone-grafting. Four patients died in the
early postoperative period, and five had inadequate follow-up. The remaining
forty-one patients (average age, seventy-two years) were evaluated clinically
and radiographically at an average of twenty-four months.
Results: All fractures healed in satisfactory alignment at an
average of twelve weeks (range, seven to twenty-three weeks) after the index
procedure. One patient had one fractured cable and two others had one
fractured screw, but all of the fractures healed without evidence of implant
loosening or malalignment. There was one deep infection in the perioperative
period. Thirty of the forty-one patients returned to their baseline ambulatory
Conclusions: The results of this study support the use of indirect
open reduction and internal fixation with a single extraperiosteal lateral
plate, without the use of allograft struts, for the treatment of a femoral
shaft fracture about a stable intramedullary implant.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.