A Dual-Implant Approach to Vancouver C Femur Fractures: Improved Outcomes With Retrograde Nail and Lateral Plate...

To compare lateral locked plating (LLP) with a combined treatment approach using a retrograde intramedullary nail alongside a minimally invasive lateral locked periprosthetic plating system (Smith & Nephew; Memphis, TN) in the management of Vancouver C periprosthetic femoral fractures.

Retrospective chart review.

Single, academic, Level-1 Trauma center.

All adult patients who underwent fixation of a Vancouver C periprosthetic femur fracture (AO/OTA Type 32C [IVC/D]) with a retrograde intramedullary nail and periprosthetic plating system (NP Group) or LLP (LLP group) between 2019 and 2025 with follow-up to union, reoperation, or a minimum of 1 year were included. Patients in the NP group were recommended to fully bear weight immediately while patients in the LLP group were recommended to remain non-weight-bearing for 8 weeks.

The primary outcome was fracture union. Secondary outcomes included implant failure, infection, and alignment immediately postoperatively and at the final follow-up. Primary and secondary outcome measures were compared between the NP and LLP groups.

A total of 52 patients were included. In total, 31 in the NP group (68% female, mean age 79 years (range, 67-99)) and 21 in the LLP group (67% female, 69 years, range: 53-85, P = 0.54 for sex, P = 0.26 for age). In both groups, the lateral plate extended proximal to the hip prosthesis by at least 3 screw holes. There were no differences when comparing body mass index, diabetes, smoking status, mechanism of injury, or fracture classification between groups ( P > 0.05). In the NP group, the mean immediate anatomic lateral distal femoral angle was 82 degrees range (79-87 degrees) compared with 80 degrees (range, 79-87 degrees) at the final follow-up ( P = 0.37; 95% CI, -5.08 to 12.9). In the LLP group, the mean immediate anatomic lateral distal femoral angle was 80 degrees (range, 63-87 degrees), compared with 82 degrees (range, 69-87 degrees) at the final follow-up ( P = 0.43; 95% CI, -5.35 to 2.37). There was no difference in alignment both immediately postoperatively and at the final follow-up between groups ( P = 0.20 and 0.45, respectively). There were 2 reoperations (6%) in the NP group, both a removal of a loose interlocking screw. There were 3 reoperations (14%) in the LLP group, all nonunions without implant failure that were revised to nail-plate constructs and subsequently achieved union. There was no difference in reoperation between groups ( P = 0.68). There were 0 nonunions in the NP group compared with 3 (14%) in the LLP group ( P = 0.03). There were no cases of implant failure or infection.

Retrograde nail/plate combination demonstrated a high union rate when treating Vancouver C periprosthetic femur fractures. When compared with LLP alone which does not facilitate immediate weight-bearing, this implant combination demonstrated lower rates of nonunion with the benefit of allowing immediate postoperative weight-bearing.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.