Case 1

This 82-years-old male patient sustained a Vancouver B1 simple non-displaced periprosthetic fracture of right non-cemented THR after a low energy fall.

The fracture was firstly reduced by a minimally invasive approach and a cerclage wire (white arrows). The patient was placed in supine position on a traction table. The fracture was fixed with a 15 holes proximal femur periprosthetic NCB plate (PF PP) adding the trochanter plate to maximize fixation where the bone stock in the proximal fragment is: the greater trochanter. The plate was bent distally to protect the fragility of the supracondylar region: a cancellous screw is driven towards the medial condyle (in polyaxial mode) to prevent future fractures in the distal metaphysis of the femur. The external jig was used to place the screws in the shaft percutaneously, except the two most distal holes because of the the bending done on the plate.

The patient started walking with two crutches the first day after the operation.

In the one and 12 months follow-up X-rays, the fracture shows no displacement with no screw loosening, although the fracture was not yet healed. The patient did not feel pain at all.

In the 18 months follow-up X-rays, the fracture heals uneventfully with indirect bone healing due to the relative stability of the construction.

Provided by Dr. Aguado Hernández Hector Jose, Hospital Clínico Universitario Valladolid, Spain

The surgical technique from this case can be found in youtube: https://youtu.be/QQvKLtUX1mg