Introduction

The locking attachment plate (LAP) can be added to a locking compression plate (LCP) to allow the fixation of locking screws bicortically around a femoral implant. We aimed to examine surgical and fracture characteristics associated with healing for periprosthetic femur fractures (PPFFx) treated with constructs employing LAP fixation. We hypothesize that the addition of an LAP provides stable peri-implant fixation.

Materials &Methods

We retrospectively reviewed a consecutive series of 28 PPFFx surgically treated with LCP-LAP constructs by 4 surgeons from 2015-2020. Fractures were classified and grouped using the Vancouver Classification System and included 12 B1, 2 B2, 11 C fractures, and 3 fractures around other stemmed implants. Primary outcome measures included hardware failure such as screw pullout, broken screws, and plate fracture. Clinical complications including infection, non-union, malunion, and reoperation were recorded.

Results

No LAP failures, screw pullout, or broken screws were observed. Two fractured plates (7.1%) occurred in patients with Vancouver C fracture types. Overall complication rate was 17.9% and included 3 non-unions, 1 deep infection, and 1 implant loosening with painful hardware, each requiring reoperation. Differences were observed between unions and nonunions for total number of screws (12.4 vs 14.7, P = .005) and number of locking screws used (8.04 vs 11.3, P = .03).

Conclusion

The LAP provides adequate fixation and low failure rates where fixation is required around a well-fixed stem. When failures occur, it is from plate breakage and not due to failure of fixation at the area of plate-stem overlap.

中文翻译：

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锁定附着板在股骨假体周围骨折内固定中的应用

介绍

锁定连接板 (LAP) 可以添加到锁定压缩板 (LCP) 上，以允许在股骨植入物周围双皮质固定锁定螺钉。我们旨在检查与采用 LAP 固定结构治疗的股骨假体周围骨折 (PPFFx) 愈合相关的手术和骨折特征。我们假设添加 LAP 可提供稳定的种植体周围固定。

材料与方法

我们回顾性地回顾了 2015-2020 年间由 4 位外科医生采用 LCP-LAP 结构进行手术治疗的 28 例 PPFFx 的连续系列。使用温哥华分类系统对骨折进行分类和分组，包括 12 例 B1、2 例 B2、11 例 C 骨折和 3 例其他带柄植入物周围的骨折。主要结局指标包括硬件故障，例如螺钉拔出、螺钉断裂和钢板断裂。记录感染、骨不连、畸形愈合和再次手术等临床并发症。

结果

没有观察到 LAP 故障、螺钉拔出或螺钉断裂。温哥华 C 型骨折患者有两处骨折（7.1%）。总体并发症发生率为 17.9%，包括 3 例不愈合、1 例深部感染和 1 例植入物因疼痛的硬件松动，均需要再次手术。在螺钉总数（12.4 对 14.7，P = .005）和使用的锁定螺钉数量（8.04 对 11.3，P = .03）方面观察到联合和不联合之间的差异。

结论

LAP 提供足够的固定和低故障率，需要在固定良好的茎周围进行固定。发生故障时，是由于钢板断裂，而不是由于钢板-茎重叠区域的固定失败。