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  • Title: [Treatment of femoral fracture on previous implants with minimally-invasive surgery and total weight-bearing: benefit of locking plate. Preliminary report].
    Author: Ehlinger M, Cognet JM, Simon P.
    Journal: Rev Chir Orthop Reparatrice Appar Mot; 2008 Feb; 94(1):26-36. PubMed ID: 18342027.
    Abstract:
    PURPOSE OF THE STUDY: We report a consecutive prospective series of femoral fractures on previous implants. The purpose was to assess treatment with locking compression plates and total weight-bearing. MATERIAL AND METHOD: From June 2002 to December 2005, we treated 21 patients (16 women, five men) for fractures on previous implants: total hip arthroplasty (n=11), total knee arthroplasty (n=1), unicompartmental prosthesis (n=1), gamma nail (n=4), hip screw (n=1). Mean patient age was 75.8 years (range 39-90). Osteosynthesis was performed on an orthopedic table or on a standard table using a minimally-invasive approach for fixation with a locking compression plate (Synthes) LCP) to bridge the implants in place and avoid any zone of weakness. The rehabilitation protocol included immediate total weight bearing. RESULTS: At last follow-up there were three deaths and one failure so that there were 17 patients with a mean follow-up of 15.9 months (range 6-45 months). The following outcomes were noted. Minimally-invasive surgery was used in 18 cases, access to the fracture focus in three. Total weight bearing was possible immediately after surgery in 12 patients and partial weight bearing (20 kg) for two. There were two infections, two general complications and one early displacement. Healing was achieved at 6-10 weeks. Misalignment greater than 10 degrees was noted in three cases. DISCUSSION: This work illustrates the use of locking plates for minimally-invasive repair of fractures on previous implants with total weight bearing. This technique combines the principles of closed fixation and preservation of the fracture hematoma with material stability. In this form, use developed progressively. It is now common practice to use plate fixation for femoral fractures. The LISS system was then developed progressively for minimally-invasive repair of distal fractures. We widened the concept to include more proximal approaches. The use of the locking screws in the plate corresponds to what could be called an internal external fixator with three pins (two corresponding to the cortical screws plus the plate), which enable a solid fixation. Screw hold seems to be sufficient to allow early weight bearing. CONCLUSION: Locking plates have been shown to be an effective treatment for femoral fractures on previous implants allowing a stable fixation sufficient for early weight bearing.
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