Periprosthetic fractures: Treatment with Dall-Miles plates [Fratture periprotesiche: Trattamento con placche Pall-Miles]

Aim. Periprosthetic fractures pose an increasing challenge to the orthopaedic surgeon as the number total hip replacement operations and revisions continue to rise. The incidence of fractures varies depending on the implantation technique and the quality of the bone where the fractures occur. Methods. From March 2003 to June 2004, 15 patients treated at the Orthopedics and Traumatology Clinic, Genoa, and the Emergency Department of the San Martino Hospital, Genoa, for B1 or B2 periprosthetic fractures (Vancouver classification: 11 type B1, 4 type B2) received a Dall-Miles plate, of which 10 were primary implantations and 5 were revisions; the mean time from surgery to fracture was 4 years (range, 6 months to 12 years). Results. In all patients examined at follow-up, the mean time to fracture union was 4.5 months; the plates were well tolerated and none of them broke. Conclusion. The Dall-Miles plates offer a wide variety of solutions in treating periprosthetic fractures. The cable feedthroughs do not require extensive periosteal stripping, thus preserving the biology of the fracture focus and making the use of allografts or autografts subsequently unnecessary, which, in the authors' opinion and in contrast with the literature, are unneeded in the presence of a stable osteosynthesis.