Novel Use of Olecranon Locking Plate With Achilles Allograft Augmentation for Fixation of Greater Trochanter Fractures After Total Hip Replacement

Abstract

Introduction: The optimal fixation method for greater trochanteric fractures after a total hip replacement remains controversial. We present the surgical technique of a novel fixation method for greater trochanteric fractures with the use of an olecranon locking plate and Achilles tendon allograft augmentation. Patients and Methods: Five patients who had previously undergone a total hip arthroplasty for primary osteoarthritis were identified as presenting with displaced (>2 cm) greater trochanter fractures between 2017 and 2021. They underwent open reduction internal fixation of the greater trochanter with an olecranon locking plate and Achilles tendon allograft augmentation an average of 8 months after their index procedure (range: 2 to 17 mo), all performed by a single surgeon. All 5 patients were women, the mean age was 59 years (range: 54 to 69 y) and the mean follow-up time was 16.1 months (range: 5 to 41 mo). Results: All 5 patients reported improved pain levels and functional status after open reduction internal fixation. Four of the patients demonstrated maintenance of the position of the trochanteric fragment with the olecranon plate whereas one patient who was unable to comply with postoperative restrictions had a catastrophic failure of the fixation. One of 5 trochanteric bones showed clear evidence of radiographic union. Conclusions: Utilization of olecranon locking plates is well suited for fixation of a greater trochanter fracture as this technique allows for the capture of small comminuted fragments by the proximal curvature of the plate. In addition, this minimizes the concurrent use of metallic cables close to or within the effective joint space. Weight-bearing restrictions and stability are of the utmost importance in the postoperative time period.