JOT - 2026-05-05 - Journal Article
A Dual-Implant Approach to Vancouver C Femur Fractures: Improved Outcomes with Retrograde Nail and Lateral Plate Fixation Compared to Lateral Locked Plating.
Page BE, Shaath MK, Rechter GR, Nasir BA, Baker TJ, Yawman JP, Jacobs E, Langford JR, Haidukewych GJ
Topics
Key Takeaway
Retrograde nail plus lateral locked plate achieved 0% nonunion versus 14% nonunion with lateral locked plate alone (p=0.03) for Vancouver C periprosthetic femur fractures.
Summary Depth
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Summary
This retrospective single-center study compared retrograde IMN plus minimally invasive lateral locked periprosthetic plating (NP group, immediate weight-bearing) versus lateral locked plating alone (LLP group, 8-week non-weight-bearing) for Vancouver C periprosthetic femur fractures. The NP group had 0 nonunions versus 3 (14%) in the LLP group (p=0.03); all 3 LLP nonunions were revised to nail-plate constructs and subsequently united. Reoperation rates (6% vs. 14%, p=0.68) and postoperative alignment did not differ significantly between groups.
Key Limitation
The retrospective non-randomized design introduces selection bias, as the NP group was treated in a later era (implying a temporal cohort effect) and the LLP group was older by trend, potentially confounding the nonunion rate comparison.
Original Abstract
OBJECTIVES
To compare lateral locked plating (LLP) to a combined treatment approach utilizing a retrograde intramedullary nail (rIMN) alongside a minimally invasive lateral locked periprosthetic plating system (PPS) (Smith & Nephew; Memphis, TN) in the management of Vancouver C periprosthetic femoral fractures.
DESIGN
Retrospective chart review.
SETTING
Single, academic, Level-1 Trauma center.
PATIENT SELECTION CRITERIA
All adult patients who underwent fixation of a Vancouver C periprosthetic femur fracture (AO/OTA Type 32C [IVC/D]) with a rIMN and PPS (NP Group) or LLP (LLP group) between 2019 and 2025 with follow-up to union, reoperation, or a minimum of one year were included. Patients in the NP group were recommended to fully bear weight immediately while patients in the LLP group were recommended to remain non-weight bearing for 8 weeks.
OUTCOME MEASURES AND COMPARISONS
The primary outcome was fracture union. Secondary outcomes included implant failure, infection, and alignment immediately postoperatively and at final follow-up. Primary and secondary outcome measures were compared between the NP and LLP groups.
RESULTS
A total of 52 patients were included. 31 in the NP group (68% female, mean age 79 years (range, 67 - 99)) and 21 in the LLP group (67% female, 69 years (range, 53 - 85)), (p = 0.54 for sex, p = 0.26 for age). In both groups, the lateral plate extended proximal to the hip prosthesis by at least 3 screw holes. There were no differences when comparing body mass index, diabetes, smoking status, mechanism of injury, or fracture classification between groups (p > 0.05). In the NP group the mean immediate aLDFA was 82 degrees range (79-87 degrees) compared to 80 degrees (range 79 - 87 degrees) at final follow-up (p = 0.37; 95% CI -5.08 to 12.9). In the LLP group the mean immediate aLDFA was 80 degrees (range, 63 - 87 degrees), compared to 82 degrees (range 69 - 87 degrees) at final follow-up (p = 0.43; 95% CI, -5.35 to 2.37). There was no difference in alignment both immediately postoperatively and at final follow-up between groups (p = 0.20 and 0.45, respectively). There were 2 reoperations (6%) in the NP group, both a removal of a loose interlocking screw. There were 3 reoperations (14%) in the LLP group, all nonunions without implant failure that were revised to nail-plate constructs and subsequently achieved union. There was no difference in reoperation between groups (p = 0.68). There were 0 nonunions in the NP group compared to 3 (14%) in the LLP group (p = 0.03). There were no cases of implant failure or infection.
CONCLUSIONS
Retrograde nail/plate combination demonstrated a high union rate when treating Vancouver C periprosthetic femur fractures. When compared to lateral locked plating alone which does not facilitate immediate weight-bearing, this implant combination demonstrated lower rates of nonunion with the benefit of allowing immediate post-operative weight bearing.
LEVEL OF EVIDENCE
Level III.