• William M Ricci, Brett R Bolhofner, Timothy Loftus, Christopher Cox, Scott Mitchell, and Joseph Borrelli.
• Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, One Barnes Hospital Plaza, Suite 11300, St. Louis, MO 63110, USA. ricciw@wudosis.wustl.edu
• J Bone Joint Surg Am. 2006 Sep 1; 88 Suppl 1 Pt 2: 275-82.

BackgroundThe application of indirect reduction techniques has improved fracture-healing and reduced the need for bone-grafting compared with the outcomes of older, direct reduction techniques. We investigated the results of such indirect reduction techniques for the treatment of periprosthetic femoral shaft fractures.MethodsFifty consecutive patients with a femoral shaft fracture about a stable intramedullary implant (a Vancouver Type-B1 fracture) were treated with a protocol that included open reduction with use of indirect reduction techniques and internal fixation with a single lateral plate without structural allografting or other bone-grafting. Four patients died in the early postoperative period, and five had inadequate follow-up. The remaining forty-one patients (average age, seventy-two years) were evaluated clinically and radiographically at an average of twenty-four months.ResultsAll fractures healed in satisfactory alignment at an average of twelve weeks (range, seven to twenty-three weeks) after the index procedure. One patient had one fractured cable and two others had one fractured screw, but all of the fractures healed without evidence of implant loosening or malalignment. There was one deep infection in the perioperative period. Thirty of the forty-one patients returned to their baseline ambulatory status.ConclusionsThe results of this study support the use of indirect open reduction and internal fixation with a single extraperiosteal lateral plate, without the use of allograft struts, for the treatment of a femoral shaft fracture about a stable intramedullary implant.

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