Locking plate fixation with cerclage augmentation and bone grafting for Vancouver B2 periprosthetic femoral fractures around cementless stems: a surgical option in elderly high-risk patients unsuitable for revision arthroplasty (mid-term outcomes)

Résumé

Objective To evaluate the mid-term clinical and radiographic outcomes of open reduction and internal fixation (ORIF) with a locking plate, cerclage wires, and bone grafting for Vancouver B2 periprosthetic femoral fractures (PFF) in elderly, high-risk patients who are unsuitable for revision arthroplasty after primary cementless total hip arthroplasty (THA). Methods A retrospective analysis was conducted on 28 elderly patients with Vancouver B2 PFFs treated with locking plate fixation and cerclage wiring. Patient demographics, operative parameters (time, blood loss), and hospital stay were recorded. Fracture healing time, Harris Hip Score (HHS), and Visual Analog Scale (VAS) were evaluated preoperatively and at the final follow-up, with VAS also assessed postoperatively. Complications were documented. Results The mean follow-up was 63.86 months (range, 24–120). During the follow-up period, three patients died due to advanced age, and two patients were lost to follow-up because of changes in contact information or failure to attend scheduled visits. Mean operative time was 176.32 ± 20.46 min, and mean blood loss was 358.93 ± 188.59 mL. All fractures united, with a mean healing time of 3.89 months. HHS improved significantly from 43.93 preoperatively to 90.32 at final follow-up ( P < 0.001), and VAS decreased from 4.11 ± 1.03 to 0.43 ± 0.50 ( P < 0.001). Postoperative DVT occurred in 7 patients (mean onset: 7.71 ± 1.11 days), including one case progressing to pulmonary embolism requiring an inferior vena cava filter; all were successfully managed with rivaroxaban. Prosthesis subsidence was observed in 5 patients, of whom 3 remained stable and were monitored, while 2 with delayed union underwent revision with distally fixed cementless stems. No other complications (infection, nonunion, implant failure, loosening, or osteolysis) were observed in the remaining patients. Kaplan–Meier analysis, with revision as the endpoint, estimated a 5-year survival rate of 92.3% (95% CI, 73.8%∼97.9%). Conclusion For selected high-risk elderly patients with Vancouver B2 PFF who are unsuitable for revision arthroplasty, ORIF with locking plate, cerclage wires, and bone grafting appears to be a potentially viable treatment option. Its success depends on rigorous case selection and standardized perioperative management, and further long-term prospective studies are warranted to confirm its durability.