Dall-Miles cable and plate fixation system in the treatment of periprosthetic femoral fractures: a review of 20 cases.

PURPOSE To assess the effectiveness of Dall-Miles cables and plates in the treatment of periprosthetic femoral fractures around hip arthroplasties. METHODS We retrospectively reviewed 20 cases of periprosthetic femoral fracture treated with the Dall-Miles cable and plate system between November 1999 and December 2002 in James Paget Hospital in the United Kingdom. Demographic data, fracture type, and surgical outcome of the patients were reviewed and assessed. RESULTS Of the 20 cases of periprosthetic femoral fracture, one was of Vancouver type A, 15 were of type B1, and 4 were of type C. The mean age at operation was 78.5 years (range, 68-90 years) with a male to female ratio of 11:9. The mean time to union was 3.9 months (range, 3-8 months), and the mean follow-up period was 19.4 months (range, 1-4 years). 15 patients achieved satisfactory results, including 2 delayed unions that healed with a residual varus deformity of 15 degrees in the femoral component. Three patients developed deep-seated wound infections. No nonunion of fractures or fixation system failures occurred. CONCLUSION The Dall-Miles cable and plate fixation system alone is a sufficient treatment for most periprosthetic femoral fractures. In the management of B1 fractures, there was no significant difference in clinical outcome, despite the various combinations of cables and screws used for stabilisation of the plate. However, in cases of comminution at the fracture site, junctional grafting with morsellised autograft may be used in addition to internal fixation to accelerate union.