Dall-Miles cable and plate fixation for the treatment of peri-prosthetic femoral fractures-analysis of results in 13 cases

We present a retrospective review of 13 patients with periprosthetic femoral fractures treated with the Dall-Miles cable and plate fixation system between 1995 and 1999. Of these, 12 fractures were in relation to hip arthroplasty and one was proximal to the femoral component of a total knee replacement. Mean age at presentation was 77 years (range 66-87) with the male female ratio of 6:7. All patients were followed up until there was evidence of clinical and radiological union. The average follow-up period was 6.5 months (range 2.5-24). We achieved satisfactory results in ten patients with average time to union of 4.4 months. The results were unsatisfactory in three patients who required further revision procedures due to failure of fixation or non-union. Internal fixation of the fracture with the loose femoral component left in-situ led to failure of union in one patient. Varus mal-alignment of the femoral component to the shaft of more than 6 degrees was associated with unsatisfactory outcome in two patients. The Dall-Miles cable and plate system is a useful method of internal fixation for majority of periprosthetic femoral fractures. This method may not be suitable if the femoral component is loose or if it is in varus angulation of more than 6 degrees to the shaft of the femur.