Dynamic internal fixation of the periprosthetic femoral fractures after total hip arthroplasty

Abstract

Periprosthetic fractures of the femur after total hip arthroplasty are a big orthopaedic problem, particularly in elderly patients and quite a challenge for orthopaedic surgeons. There is no universal method in treating these fractures. Rigid plates fixation can be limited and aggravated especially in the proximal part of the femur where the endoprosthesis stem does not allow for an undisturbed fixation of both femur cortexes by means of screws. Mitkovic's dynamic internal fixator is an original implant allowing for an undisturbed fixation of both femur cortexes regardless of the presence of the endoprosthesis stem. Fixation is made possible by means of movable clamps and a convergent possibility to place screws. A dynamic internal fixator can fix all types of periprosthetic femoral fractures. The paper shows the early experience in fixating periprosthetic femoral fractures after total hip arthroplasty in 14 patients, average age 69.7. According to Vancouver classification, 3 patients had the type A fracture, 9 patients had the type B fracture, and 2 patients had the type C fracture. All fractures were fixed by Mitkovic's dynamic internal fixator. The fracture occurred 2-12 years after primary total hip arthroplasty. The follow-up of the operated patients was 12 months. The method is less invasive than the methods described in books. Mechanical complications are not likely to appear due to the fracture dynamics along the femoral shaft axis, which is made possible by this implant. Our initial experience in femur fracture fixation after hip arthroplasty ahows that it is modern and effective dynamic implant which will contribute significantly to the improving of the treatment of these often very complicated fractures.