Abstract
INTRODUCTION: We describe percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO) for periprosthetic femoral shaft fractures. STEP 1 PREOPERATIVE PLANNING AND ASSESSMENT OF THE LENGTH ALIGNMENT AND ROTATION OF THE EXTREMITY: A well-developed preoperative plan and assessment of the length, alignment, and rotation of the extremity are critical. STEP 2 PREPARE THE TUNNEL: After making the appropriate incision, use the tunneling device anterior and posterior to the femur to create a soft-tissue tunnel. STEP 3 INSERT AND CONNECT THE CERCLAGE PASSER: Insert the cerclage passer carefully by keeping it in close contact with the bone. STEP 4 INSERT THE CERCLAGE WIRE AND REMOVE THE WIRE PASSER: The cerclage wire may be incrementally inserted according to the direction on the passer to prevent kinking. STEP 5 PLACE AND FIX THE SUBMUSCULAR PLATE: Verify the alignment and length of the plate with intraoperative images and precontour the plate to fit the lateral aspect of the femur as necessary. STEP 6 CLOSURE AND POSTOPERATIVE REHABILITATION: Encourage an immediate range of motion to aid in postoperative recovery. RESULTS: In our original study, ten patients with a Vancouver type-B1 periprosthetic femoral shaft fracture (mean age, seventy-four years; range, forty-seven to eighty-four years) were treated with the described percutaneous cerclage wire and MIPO techniques.IndicationsContraindicationsPitfalls & Challenges.