Peri-prosthetic femoral shaft fractures treated with plate and cable fixation

Management of post-operative peri-prosthetic femoral shaft fractures remain s difficult and controversial, with no widely accepted form of treatment. F ractures at the tip of a femoral component are associated with poor union r ates. We present a series of 15 fractures at the component tip extending pr oximally in association with a loose cement mantle. All 15 patients were tr eated with open reduction and internal fixation using a plate and cable sys tem. They were followed to clinical and radiological union, at an average o f 3.5 months (range 3-5 months). At final review examination, 13 patients h ad achieved pre-fracture mobility, with one patient requiring a single walk ing stick, and one requiring a Zimmer frame. Three patients under-went revi sion surgery after successful fracture union and rehabilitation, with long stemmed femoral components. The plate and cable procedure is not technicall y demanding and avoids hip exposure. This form of internal fixation provide s immediate fracture stability, allowing early ambulation, hence avoiding t he complications and difficulties of other methods of treatment. Such fract ures should be acutely treated to achieve fracture union with a plate, cabl e, and screw internal fixation technique. The loose components can be revis ed electively, preferably by a revision hip surgeon. (C) 1999 Elsevier Scie nce Ltd. All rights reserved.