Dall-Miles cable and plate fixation system in the treatment of periprosthetic femoral fractures: a review of 20 cases

PURPOSE: To assess the effectiveness of Dall-Miles cables and plates in the treatment of periprosthetic femoral fractures around hip arthroplasties. METHODS: We retrospectively reviewed 20 cases of periprosthetic femoral fracture treated with the Dall-Miles cable and plate system between November 1999 and December 2002 in James Paget Hospital in the United Kingdom. Demographic data, fracture type, and surgical outcome of the patients were reviewed and assessed. RESULTS: Of the 20 cases of periprosthetic femoral fracture, one was of Vancouver type A, 15 were of type B1, and 4 were of type C. The mean age at operation was 78.5 years (range, 68-90 years) with a male to female ratio of 11:9. The mean time to union was 3.9 months (range, 3-8 months), and the mean follow-up period was 19.4 months (range, 1-4 years). 15 patients achieved satisfactory results, including 2 delayed unions that healed with a residual varus deformity of 15 degrees in the femoral component. Three patients developed deep-seated wound infections. No nonunion of fractures or fixation system failures occurred. CONCLUSION: The Dall-Miles cable and plate fixation system alone is a sufficient treatment for most periprosthetic femoral fractures. In the management of B1 fractures, there was no significant difference in clinical outcome, despite the various combinations of cables and screws used for stabilisation of the plate. However, in cases of comminution at the fracture site, junctional grafting with morsellised autograft may be used in addition to internal fixation to accelerate union.     

Dall-Miles cable and plate system for periprosthetic femoral fracture

Management of femoral shaft fractures in association with hip implants in situ is a difficult and complex problem. We present here our experience of nine periprosthetic femoral fractures treated successfully with open reduction and internal fixation using the Dall-Miles plate and cable system. We recommend this system for fixation of the type 3 fractures using a minimum of three proximal cables and three distal cables with supplementary screws. Résumé. La gestion des fractures de la diaphyse fémorale associées à des prothèses de hanche est un problème difficile et complexe. Nous présentons ici notre expérience de 9 fractures fémorales péri-prothétiques traitées avec succès par réduction ouverte et fixation interne utilisant des plaques de Dall-Miles. Nous recommandons ce système d'ostéosynthèse des fractures de type 3 avec un minimum de 3 câbles proximaux et 3 câbles distaux avec des vis supplémentaires.     

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

Management of post-operative peri-prosthetic femoral shaft fractures remains difficult and controversial, with no widely accepted form of treatment. Fractures at the tip of a femoral component are associated with poor union rates. We present a series of 15 fractures at the component tip extending proximally in association with a loose cement mantle. All 15 patients were treated with open reduction and internal fixation using a plate and cable system. They were followed to clinical and radiological union, at an average of 3.5 months (range 3-5 months). At final review examination, 13 patients had achieved pre-fracture mobility, with one patient requiring a single walking stick, and one requiring a Zimmer frame. Three patients under-went revision surgery after successful fracture union and rehabilitation, with long stemmed femoral components. The plate and cable procedure is not technically demanding and avoids hip exposure. This form of internal fixation provides immediate fracture stability, allowing early ambulation, hence avoiding the complications and difficulties of other methods of treatment. Such fractures should be acutely treated to achieve fracture union with a plate, cable, and screw internal fixation technique. The loose components can be revised electively, preferably by a revision hip surgeon.     

The Mennen plate: unsuitable for elderly femoral peri-prosthetic fractures.

The Mennen plate has been advocated for femoral shaft and femoral peri-prosthetic fractures. We utilised this fixation system in five patients with peri-prosthetic femoral shaft fractures. The operative technique was that described by the CMW laboratories. The postoperative regimen deviated from that recommended, i.e. prolonged bed-rest, since the patients were elderly and complicated by chest problems and pressure sores. Once the surgical wounds had healed, at an average of 11 days (range 10-14 days), one patient achieved non-weight-bearing mobilisation. Four patients were managed with bed-to-chair transfer only. All five plates failed at an average of 32 days (range 15-42 days). Only one patient had an identifiable accident to account for the failure. Two patients underwent revision hip arthroplasty and two had revision fixation with Dall-Miles (Howmedica), and Cable Ready (Zimmer) plate and cables. Femoral shaft peri-prosthetic fractures are not adequately stabilised with the Mennen plate system, and prolonged recumbency in such an elderly population often worsens pre-existing medical problems. We advocate the use of one of the many available plate and cable fixation systems for such fractures in the elderly and in those in whom revision arthroplasty may not be possible.     

双钢板治疗股骨远端粉碎性骨折

股骨远端粉碎性骨折合并干骺端、髁间骨折,属关节内骨折,多为高能量损伤所致,骨折波及关节面。因而一般内固定（角钢板、解剖钢板）稳定性不确切,需辅以长时间外固定,并发症较多。2003年1月～2007年6月,笔者采用双切口入路双钢板内固定21例,取得良好疗效。     

锁定钢板辅助固定治疗股骨髓内钉术后骨不连

目的 :探讨有限切开应用锁定钢板辅助髓内钉治疗股骨干髓内钉术后骨不连的临床疗效。方法 :回顾性分析2006年1月至2015年12月采用有限切开方式锁定钢板辅助固定治疗的40例股骨骨折髓内钉固定术后骨不连患者的临床资料,其中男22例,女18例;年龄21~60岁,平均(35.0±2.2)岁。骨不连时间为9~24个月,平均(14.1±1.5)个月。观察患者的手术时间、术中出血量、住院时间、并发症、骨折愈合时间、膝关节功能恢复情况,并采用Evanich评分标准对其临床疗效进行评价。结果:40例患者均获随访,时间12~24个月,平均(15.2±2.7)个月。手术时间105.1~130.2 min,平均(112.5±10.2)min;术中出血量207.0~250.2 ml,平均(220.6±14.7)ml;住院时间10~15 d,平均(12.2±1.5)d。患者在附加钢板固定术后4~12个月获得骨性愈合,平均愈合时间(6.2±1.9)个月。术后未出现内植物失效、感染等并发症。根据膝关节Evanich评分:总分83.2±5.6,优22例,良17例,中1例。结论:股骨干髓内钉术后出现骨不连应用有限切开锁定钢板辅助原有髓内钉固定疗效显著,增加了骨折端的稳定性,为骨痂生长提供了稳定的环境,治愈率高,术后创伤小,并发症少,可以尽早功能锻炼,促进膝关节功能恢复良好。     

Use of a Dall-Miles plate and cables for the fixation of a periprosthetic humeral fracture

Increase in the use of shoulder arthroplasty has resulted in the emergence of periprosthetic fractures of the humerus. The management of such fractures is technically demanding. We describe a case in which a displaced periprosthetic fracture at the tip of a stable humeral implant was successfully managed with the Dall-Miles plate and cables system.     

Use of a Dall-Miles plate and cables for the fixation of a periprosthetic tibial fracture

Although tibial periprosthetic fractures are uncommon, they are likely to be encountered more frequently with the increased use of total knee arthroplasty, and they present a challenging management problem. Here we present our solution to this problem, which provided a safe, effective means of fracture management, while maintaining the prosthesis.     

Dall-Miles plates for periprosthetic femoral fractures. A critical review of 16 cases

Fourteen patients with 16 periprosthetic femoral fractures around hip replacement were treated with Dall-Miles plates between June 1996 and February 2000.There were 10 Vancouver B3, three B1 and three type C fractures. In addition to a Dall-Miles plate, two of the fractures (one B3 and one C type) were also stabilised with one strut graft and nine B3 fractures were revised with impaction grafting.Of the three B1 fractures treated with plates, two failed through fracture of the plate. A further two patients with B3 fractures treated with plates also failed with fracture of the plate. Failure of these plates occurred within 6 months of surgery.All non-unions and fixation failures in this series were in cases where the femoral component did not bypass the most distal fracture line by at least two cortical diameters.The Dall-Miles plates and cable system alone is insufficient for the treatment for periprosthetic femoral fractures. It must be supplemented with additional intramedullary or extramedullary fixation.     

锁定接骨板内固定治疗全髋关节置换术后假体周围骨折

2007年2月-2013年2月,我科应用锁定接骨板治疗21例全髋关节置换术后股骨假体周围骨折Vancouver B型患者,获得较好的效果,报道如下.     

股骨近端锁定钢板治疗不稳定股骨转子间骨折

目的探讨股骨近端锁定钢板治疗不稳定股骨转子间骨折的临床疗效。方法对27例不稳定型股骨转子间骨折患者采用股骨近端锁定钢板内固定。结果 27例均获随访,时间4~18个月。1例出现髋内翻畸形。26例均获骨性愈合,愈合时间4~7个月。末次随访时髋关节功能按Harris评分标准评定:优14例,良9例,可3例,差1例。结论股骨近端锁定钢板内固定治疗不稳定股骨转子间骨折具有创伤小、并发症少、内固定可靠、骨折愈合率高等优点,适用于不稳定型股骨转子间骨折,特别是伴有骨质疏松症患者。     

Locked plate fixation for femoral shaft fractures

Fifteen patients with a mean age of 31 years, who had sustained different types of femoral shaft fracture, were treated by locked plate fixation using standard AO dynamic compression plates (DCP). The fracture was open in five patients and ten had other significant injuries. Thirteen patients were available for follow-up at a mean period of 5 months (range, 3-10 months). All fractures united and the mean time to full weight bearing was 8 weeks. Screw failures, with breakage or bending, occurred in five patients and resulted in loss of alignment of the fracture in one. Nine patients regained a full active range of movement of the knee, two had an extension lag of 10 degrees and two had restricted flexion. The strength of the quadriceps muscle was grade 4 to 5 in ten patients and grade 3 in the remaining three. At the end of the study period ten patients had returned to their normal activities, one used a walking stick and two remained under a rehabilitation programme. Our preliminary results suggest that locked plates may offer a useful alternative technique for the treatment of femoral shaft fractures.     

Double locking plate fixation for femoral shaft nonunion

Introduction

Nonunions after operative fixation of the femur, although infrequent, remain a challenge for orthopedic surgeons. The aim of this study was to assess the effectiveness of double locking plate fixation in the treatment for femoral shaft nonunions.

Materials and methods

From 2009 to 2013, 21 patients with femoral nonunions (mean age 46.9 years, range 25–81) were treated and evaluated utilizing double locking plate fixation. Patients were followed for at least 6 months postoperatively or until they achieved complete union to investigate bone healing and functional outcomes in femoral shaft nonunions treated with double locking plate and autogenous cancellous bone graft.

Results

The main outcomes evaluated were the presence of bony union, time to achieve union, and SF-36 score. All 21 femoral nonunions healed (100 % union rate). The average time to bony union was 5.3 months (range, 4–7). The mean follow-up duration time was 24.8 months (range, 6–60). Average scores of the physical function and bodily pain components of the SF-36 were 96 (range, 90–99) and 94.2 (range, 92–99), respectively. No significant complications were noted postoperatively.

Conclusion

Because of the high union rates and lack of significant complications in our series, double locking plate fixation can serve as an effective method of addressing femoral shaft nonunions. No significant complications were found postoperatively.