Minimally invasive plate osteosynthesis (MIPO) of periprosthetic femoral fractures with percutaneous cerclage wiring for fracture reduction: tips and technique

Abstract

Introduction: Periprosthetic femoral fractures (PPFs) associated at or near a well-fixed femoral prostheses (Vancouver type-B1) present a clinical challenge due to the quality of the bone stock and instability of the fracture. Combining closed reduction techniques with minimally invasive plate osteosynthesis (MIPO) or intramedullary nailing is a technically challenging procedure, especially when dealing with complex femoral fractures such as periprosthetic fractures. Cerclage wiring is a well known adjunct for fracture reduction and fixation. However, it is usually performed by open reduction, requiring wide surgical exposures, that results in soft tissue stripping.

Materials and Methods: In our original study 18 patients with periprosthetic femoral shaft fracture (mean age, seventy-four years; range, forty-seven to eighty-four years) were treated with the described percutaneous cerclage wire and MIPO techniques. One patient died two months postsurgery, leaving seventeen patients who were followed for a mean of 13.2 months.

Results and Discussion: Four patients sustained a spiral fracture pattern; three, an oblique fracture; and two, a wedge fracture. Closed reduction was successful in all but one case, and took a mean of 24.4 minutes (range, seven to forty-five minutes). The mean total operative time was 103 minutes (range, seventy-five to 140 minutes). Blood loss was <100 ml in all cases. All fractures united at a mean of eighteen weeks (range, sixteen to twenty weeks). No hardware failures were observed; one plate bent 100, but the bending did not progress and the fracture healed uneventfully at sixteen weeks. Seven of the nine patients were able to return to their previous level of mobility. During the application of the percutaneous cerclage wires, there were no vascular or nerve injuries and none of the patients returned with any wound complications.