Polyaxial locking plate fixation in periprosthetic, peri-implant and distal shaft fractures of the femur : a comparison of open and less invasive surgical approaches


Periprosthetic fracture ; peri-implant fracture ; fragility fracture ; polyaxial locking plate ; femur fracture

Published online: May 29 2020

Florian Hess, Christoph Knoth, JoEllen Welter, Ralph Zettl, Susanne Dörr

From the Department of Orthopaedics and Traumatology, Cantonal Hospital, Frauenfeld, Switzerland


Polyaxial locking plate fixation is a widely performed treatment for femoral shaft, periprosthetic, and peri-implant fractures in elderly patients. This study’s purpose was to compare patient outcomes following the open technique (OT) and less invasive techniques (LIT).

Data were gathered from 44 patients with 46 fractures treated with polyaxial locking plate between 2010-2015. Twenty fractures underwent the OT and 26 had a LIT. Long-term assessments for 83% of the fractures were done at a median of 23 months postoperatively.

Bone healing rates were 82% in the OT and 100% in the LIT group (p=0.0688). The difference in the median duration of the surgery (OT 120 minutes, LIT 73 minutes) (p< 0.001) was the main statistically significant finding.

Both surgical techniques resulted in similarly favourable outcomes. The LIT would be the preferred operating technique, especially when treating patients more susceptible to intra- and/or postoperative morbidity.