Dynamic compression plate fixation for post-operative fractures around the tip of a hip prosthesis

Post-operative fractures around the tip of the femoral component of a hip prosthesis are inherently unstable and have been reported to be associated with high nonunion rate if treated conservatively. A group of 27 of these fractures were treated with dynamic compression plates between 1994 and 2000. The fractures followed primary total hip arthroplasty in 10 cases, revision surgery in five cases and hemiarthroplasty in 12 cases. According to the Vancouver classification, there were 18 type B1, six type B2 and three type B3 fractures. The average age was 82 years. The average follow up was 35.7 months (range 12-72 months). Complications included one nonunion (B3) and three fixation failures (one B2 and two B3). Also, two cases became infected, one of these was managed conservatively, the other needed removal of plate and prosthesis. Twenty patients regained their pre-injury mobility. Dynamic compression plate fixation is sufficient for type B1 and some selected cases of type B2 fractures that occur around the tip of a hip prosthesis.