I read with interest the paper of Kamineni, Vindlacheruvu and Ware on Peri-prosthetic femoral shaft fractures treated with plate and cable fixation, Injury 1999; 30: 261–268. They should be congratulated for undertaking the care of these difficult and increasingly common problems. I would, however, strongly question one of their central themes. They state that fixation should be undertaken even in the presence of a loose stem. Whilst open reduction and internal fixation is the preferred treatment when a fracture occurs around a solidly fixed stem [
- Brady O.H.
- Garbuz D.S.
- Masri B.A.
- Duncan C.P.
Periprosthetic fractures after major joint replacement. Classification of the hip.
Orthop. Clin. North Am. 1999; 30: 215-220
- Chandler H.P.
- King D.
- Limbird R.
- Hedley A.
- McCarthy J.
- Penenberg B.
- Danylchuk K.
The use of cortical allograft struts for fixation of fractures associated with well-fixed total joint prostheses.
Semn. Arthroplasty. 1993; 4: 99-107
3], this cannot be extended to the situation where the stem is already loose, and the resulting motion or osteolysis have potentially contributed to the fracture.
- Duncan C.P.
- Masri B.A.
Fractures of the femur after hip replacement.
in: American Academy of Orthopaedic Surgeons Instructional Course Lectures. vol. 44. CV Mosby, St Louis1995: 293-304
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- Periprosthetic fractures after major joint replacement. Classification of the hip.Orthop. Clin. North Am. 1999; 30: 215-220
- The use of cortical allograft struts for fixation of fractures associated with well-fixed total joint prostheses.Semn. Arthroplasty. 1993; 4: 99-107
- Fractures of the femur after hip replacement.in: American Academy of Orthopaedic Surgeons Instructional Course Lectures. vol. 44. CV Mosby, St Louis1995: 293-304
- The Dall–Miles cable and plate system in the management of periprosthetic fractures.Injury. 1997; 28: 445-448
- Surgical management of intra- and post-operative fractures of the femur about the tip of the stem in total hip arthroplasty.J. Arthroplasty. 1996; 11: 709-717
Accepted: September 20, 1999
Received: June 19, 1999
© 2000 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.