MIPPO Combined With NCB.PP for Treating Vancouver Type B Femoral Periprosthetic Fractures

The periprosthetic fractures occur frequently in modern society, and Vancouver type B fractures have the highest incidence. Surgical treatment of fractures was necessary; however, the traditional operations have obvious disadvantages. This study aimed to explore the clinical efficacy of a novel technique-minimally invasive percutaneous plate osteosynthesis (MIPPO) combined with noncontact bridging plate for periprosthetic fracture (NCB.PP) for treating Vancouver type B femoral periprosthetic fractures.

The clinical data of 24 patients with Vancouver type B femoral periprosthetic fractures who were admitted between October 2018 and January 2023 were retrospectively analyzed. Fourteen were male and 10 were female; the average age was 74.82 ± 12.11 years (range 65-93 years). All patients underwent biological hip arthroplasty, including 14 total hip replacements and 10 hemi-arthroplasties. All patients were injured by falls, and the average time from injury to hip replacement was 17.16 ± 7.17 months (range 7-34 months). According to Vancouver classification, 7, 14, and 3 patients were type B1, B2, and B3 fractures, respectively. Both MIPPO and NCB.PP were employed for fracture reduction and fixation for all patients. All patients were followed up for 18 months continuously. The operation duration, intraoperative blood loss, number of bicortical screws at the proximal end of the fracture, postoperative complications, fracture healing rate, and time of fractures were recorded for all the patients. The clinical efficacy was assessed using the Harris Hip Score.

The average operation duration was 83.33 ± 12.16 min (range 60-150 min), the average intraoperative blood loss was 448.14 ± 186.24 mL (range 300-750 mL), and the average number of bicortical screws at the proximal end of the fracture was 3.62 ± 0.57 (range 3 ± 5). The fracture healing rate was 91.67%, and the average healing time was 7.83 ± 1.24 months (6-18 months). The average Harris Hip Score in the last follow-up was 73.75 ± 12.62 (range 45 ± 95). No cases of reduction loss, internal fixation failure, prosthesis dislocation, or renovation were reported. Two cases of superficial wound infection, three cases of postoperative pulmonary infection, and three cases of postoperative urinary tract infectionwere successfully treated with targeted interventions.

MIPPO combined with NCB.PP for treating Vancouver type B femoral periprosthetic fractures can shorten the operation duration, reduce intraoperative blood loss, alleviate iatrogenic surgical trauma, provide sufficient internal fixation strength, facilitate fracture healing, and stabilize the prosthesis effectively, and can be recommended for clinical use.