Surgical Techniques   |    
Indirect Reduction and Plate Fixation, without Grafting, for Periprosthetic Femoral Shaft Fractures About a Stable Intramedullary ImplantSurgical Technique
William M. Ricci, MD1; Brett R. Bolhofner, MD2; Timothy Loftus, BA1; Christopher Cox, BA1; Scott Mitchell, MD3; Joseph BorrelliJr., MD1
1 Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, One Barnes Hospital Plaza, Suite 11300, St. Louis, MO 63110. E-mail address for W.M. Ricci: ricciw@wudosis.wustl.edu
2 All Florida Orthopaedic Associates, P.O. Box 76359, St. Petersburg, FL 33734
3 Department of Orthopaedic Surgery, University of California at Los Angeles, 200 UCLA Medical Plaza, Suite 140, Los Angeles, CA 90095-6907
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart@haderermuller.com).
Investigation performed at the Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, Missouri, and All Florida Orthopaedic Associates, St. Petersburg, Florida
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 87-A, pp. 2240-2245, October 2005

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Sep 01;88(1 suppl 2):275-282. doi: 10.2106/JBJS.F.00327
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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.


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.


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 status.


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.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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