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
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.