Periprosthetic fractures around femoral stem: Role of reversed contralateral distal femur locking plate

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 35-39 | Devarshi Rastogi, Mukesh Kumar Dwivedi, Shah Wali Ullah.

Authors: Devarshi Rastogi [1], Mukesh Kumar Dwivedi [1], Shah Wali Ullah [1].

[1] Department of Orthopaedic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India..

Address of Correspondence
Dr. Devarshi Rastogi,

Department of Orthopaedic Surgery,

King George’s Medical University, Nabiullah Road, Daliganj, Lucknow, Pin 226018, India.



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, cable system (Stryker Howmedica, Rutherford, New Jersey), dynamic compression plates, conventional plates, cerclage cables, locking compression plates, and strut allogras 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 intraoperative demonstration of prosthesis stability and correct classification of these fractures.

Materials and Methods: Ten periprosthetic femoral shaft fractures, vancouver Type B1, were enrolled in the study. Average age of the patient was 57.6 years with 8 male and 2 female. All patients were managed by open reduction and internal xation by reversed contralateral distal femur locking plate and cables 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 86.5. One patient had superficial wound infection. e 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 the management of vancouver B1 periprosthetic femoral shaft fracture.

Keywords: Vancouver B1 fracture, locking plate, total hip arthroplatsy.


1. Hou Z, Bowen TR, Smith WR. Periprosthetic femoral fractures associated with hip arthroplasty. Orthopedics 2010;33:908.
2. Katz JN, Wright EA, Polaris JJ, Harris MB, Losina E. Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: A cohort study. BMC Musculoskelet Disord 2014;15:168.
3. Fleischman AN, Chen AF. Periprosthetic fractures around the femoral stem: Overcoming challenges and avoiding pitfalls. Ann Transl Med 2015;3:234.
4. Froberg L, Troelsen A, Brix M. Periprosthetic vancouver type B1 and C fractures treated by locking-plate osteosynthesis: Fracture union and reoperations in 60 consecutive fractures. Acta Orthop 2012;83:648-52.
5. Schwarzkopf R, Oni JK, Marwin SE. Total hip arthroplasty periprosthetic femoral fractures: A review of classification and current treatment. Bull Hosp Jt Dis (2013) 2013;71:68-78.
6. Kim Y, Tanaka C, Tada H, Kanoe H, Shirai T. Treatment of periprosthetic femoral fractures after femoral revision using a long stem. BMC Musculoskelet Disord 2015;16:113.
7. Ehlinger M, Brinkert D, Besse J, Adam P, Arlettaz Y, Bonnomet F, et al. Reversed anatomic distal femur locking plate for periprosthetic hip fracture fixation. Orthop Traumatol Surg Res 2011;97:560-4.
8. Russo M, Malekzadeh AS, Hampton C, Hymes R, Schwartzbach C, Schulman J, et al. Reversed contralateral LISS plate for Vancouver B1 periprosthetic femoral shaft fractures. Orthopedics 2015;38:e467-72.
9. Corten K, Vanrykel F, Bellemans J, Frederix PR, Simon JP, Broos PL, et al. An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component. J Bone Joint Surg Br 2009;91:1424-30.
10. Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE. Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: A biomechanical study of 5 techniques. J Arthroplasty 2000;15:523-8.
11. Pike J, Davidson D, Garbuz D, Duncan CP, O’Brien PJ, Masri BA, et al. Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg 2009;17:677-88.
12. Mukundan C, Rayan F, Kheir E, Macdonald D. Management of late periprosthetic femur fractures: A retrospective cohort of 72 patients. Int Orthop 2010;34:485-9.
13. Buttaro MA, Farfalli G, Paredes Núñez M, Comba F, Piccaluga F. Locking compression plate fixation of Vancouver Type-B1 periprosthetic femoral fractures. J Bone Joint Surg Am 2007;89:1964-9.
14. Ebraheim NA, Gomez C, Ramineni SK, Liu J. Fixation of periprosthetic femoral shaft fractures adjacent to a well-fixed femoral stem with reversed distal femoral locking plate. J Trauma 2009;66:1152-7.
15. Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H. Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 2006;88:1215-22.
16. Naqvi GA, Baig SA, Awan N. Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty. J Arthroplasty 2012;27:1047-50.
17. Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish national hip arthroplasty register. J Arthroplasty 2005;20:857-65.
18. Larsen MS, Brix M, Froberg L. Treatment of Vancouver B1 fractures-contemporary principles for the use of locking plates. Eur Orthop Traumatol 2013;4:77.
19. Graham SM, Moazen M, Leonidou A, Tsiridis E. Locking plate fixation for Vancouver B1 periprosthetic femoral fractures: A critical analysis of 135 cases. J Orthop Sci 2013;18:426-36.
20. Cooke PH, Newman JH. Fractures of the femur in relation to cemented hip prostheses. J Bone Joint Surg Br 1988;70:386-9.
21. Serocki JH, Chandler RW, Dorr LD. Treatment of fractures about hip prostheses with compression plating. J Arthroplasty 1992;7:129-35.
22. Haidar SG, Goodwin MI. Dynamic compression plate fixation for post-operative fractures around the tip of a hip prosthesis. Injury 2005;36:417-23.

How to Cite this Article: Srivastava D, Verma V, Kumar A. e role of concern and risk perception in anti-osteoporosis behavior. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):35-39.

(Abstract)      (Full Text HTML)   (Download PDF)