Challenges of Plate Fixation for Vancouver Type-C fractures after a Well-fixed Hip Arthroplasty Femoral Stem

The fixation of distal femoral fractures (Vancouver type-C fractures; Figure A) following a well-fixed hip arthroplasty femoral stem has become a challenging issue for orthopedic surgeons due to the interprosthetic biomechanical effects (e.g., negative, positive, and torsional strains). Surgeons have adopted a range of constructs, such as distal femoral locking plate, to overcome these difficulties (1, 2). To minimize the risk of interprosthetic fracture between the femoral stem and femoral plate, many surgeons prefer to overlap the lateral plate with the tip of the well-fixed femoral stem or the proximal femoral component, along with soft tissue sparing techniques using long plates [Figure B]. On the other hand, other surgeons prefer to separate (non-overlap) the plate from the femoral stem. However, the superiority of overlapping the plate over non-overlapping is not well demonstrated in any highquality studies. It is probable that the heterogeneity of these fractures, particularly with regard to the length of fracture, has limited research to support the better method. For example, a short fracture is likely to be well-treated by a non-overlapping plate (separate fixation). However, in these cases, the precise distance and position between the end of the lateral femoral plate and the tip of the wellfixed hip arthroplasty femoral stem remained unclear, thereby requiring further research (1, 4-6). In distal femoral fractures, the plate is typically placed as distal as possible to maximize the implant fixation in the distal fragment.