Abstract
Objective: The short-term results of treatment for Periprosthetic femoral shaft fracture after total hip arthroplasty have not always been satisfactory, especially when the Dall-Miles system was used alone for loosening fractures, when it should be supplemented with additional fixation according to recent reports; but there is always concern about the long-term survival of prostheses. The aim of this study was to evaluate fracture healing and hip functional outcome with a follow-up time of at least 5 years after periprosthetic fractures of the hip, using the Dall-Miles system and strut grafts.
Methods: There were eleven periprosthetic femoral fractures (three Vancouver B1, four B2, three B3, and one type C) . We had used the Dall-Miles cable and plate system supplemented with cortical autograf t from the patient's own fibula. For the five cases with stable implants we used only the Dall-Miles system and bone struts, and for the six loosening cases we revised the implants with associated cables and strut graft support. Fracture union was assessed with plain x-rays, and quali-tative assessment was based on a questionnaire. The average time to fracture from the previous arthroplasty was 6.5 years (range 5 months to 15 years) . The mean follow-up was 6.6 years (range 5-10 years) .
Results: All the fractures united within 18 weeks with no breaking of plates, and no refracture. Pain relief was anticipated and the questionnaire scores were not statistically significantly different between pre-fracture and postoperatively, but there was a trend toward lower functional scores for mid-term postoperatively.
Conclusion: It appears that the Dall-Miles system is a reliable technique to treat periprosthetic femoral fractures. Even when the prosthesis is unstable, the additional use of cortical onlay grafts with cables leads to fracture healing and to keeping satisfactory alignment for a long time, in our opinion.
