[Cortical strut grafts, an alternative to conventional plating in periprosthetic fractures of the femur].

AIM: In periprosthetic fracture therapy plating has a failure rate between 30 to 50 %. Cortical allografts proved to unite constantly in revision surgery of the femoral shaft. The hypotheses to be answered in this study was whether the use of cortical allografts increases the success rate in contrast to plating.

METHOD: A retrospective case control study has been done analysing the results in periprosthetic fractures of the femur around or below the tip of a stable femoral component (Vancouver B1, Mont III + IV).

RESULTS

In 12 plating cases an average of 2.67 units of blood was transfused (0 - 6). In the follow-up two refractures, one loosening of the femoral component and one varus deformity greater than 10 degrees occurred. In 6 patients a total of 9 reoperations had to be done. According to the classification of Mont the results were excellent in 50 %, good in 16.7 % and poor in 33.3 %. 7 patients with strut grafts received an average of 1,43 units of blood transfused (0 - 3). In one patient with a 16 degrees varus deformity of the femur, due to multiple previous operations, a deformity of 21 degrees had to be accepted. Until now, no further operation had to be done in this group. The results were classified as excellent in 5 cases (71.4 %) and good in the other 2 (28,6 %). There was no poor result. The difference between the groups was statistically significant in the number of reoperations (p < 0. 05).

CONCLUSION

In this study, with a low number so far, the strut graft group reached better results in every single variable, with a significant reduction of reoperations.