Surgical fixation of Vancouver type B1 periprosthetic femur fractures: a systematic review.

OBJECTIVES: Vancouver type B1 periprosthetic femur fractures occur around a stable implant and are typically treated with open reduction and internal fixation (ORIF). Different fixation techniques are described in the literature, and there is a lack of consensus regarding the best operative fixation strategy. The purpose of this investigation was to systematically review and compare the most commonly used fixation strategies for these fractures.

DATA SOURCES: A database search was performed using PubMed, MEDLINE, and Cochrane databases to identify studies published in English language from 1985 to 2013.

STUDY SELECTION: Articles with a minimum of 5 patients with type B1 periprosthetic femur fractures and containing outcome data regarding nonunion, malunion, infection, and reoperation rate were included.

DATA EXTRACTION: Studies were analyzed and categorized into 4 groups: group 1: ORIF with cortical strut allografts alone, group 2: ORIF with cable plate/compression plates alone, group 3: ORIF with cable plate/compression plates and cortical strut allograft, group 4: ORIF with locking plates alone. Individual patient outcomes were extracted for each study and pooled for each of the 4 groups. Data analysis was performed comparing rates of nonunion, malunion, hardware failure, infection, and reoperation.

DATA SYNTHESIS: Data were analyzed using Review Manager and SAS 9.3.

CONCLUSIONS: In total, 333 patients identified with an overall rate of 5% nonunion, 6% malunion, 5% infection, 4% hardware failure, 9% reoperation, and 15% total complications. When comparing outcomes for different modes of fixation, compared with cable plate/compression plate systems, locking plates had a significantly higher rate of nonunion (3% vs. 9% P = 0.02) and a trend toward a higher rate of hardware failure (2% vs. 7%, P = 0.07). There are limitations to this study, and further investigation with high-quality randomized controlled trials is needed to effectively compare treatment strategies.