PERIPROSTHETIC HIP FRACTURE [Case 1] · Trochanteric Plate + Cerclage

The treatment of periprosthetic hip fractures in stable cemented prostheses requires individualized planning, mastery of re-approaching in a fibrotic field, and technical capability to perform a secure hybrid fixation without implant revision. This training presents the complete management of a periprosthetic hip fracture with a stable cemented prosthesis using a postero-lateral approach combined with osteosynthesis with a trochanteric plate, application of perifemoral cables and cortical screws, with strategies for proximal anchorage, torque control in osteoporotic bone, and immediate postoperative full weight-bearing, demonstrated in detail from a surgical perspective. TRAINING FOCUS Postero-lateral approach and anatomical landmarks in re-approach. Surgical planning for periprosthetic hip fractures. Assessment of prosthetic stability and decision for fixation without revision. Anatomical exposure in a fibrotic field and identification of planes. Proximal plate anchorage via transtendinous portals. Technique for passing perifemoral cables with passer selection. Torque control of cables in osteoporotic bone. Cortical screw fixation in an oval hole with prosthesis deviation. Stabilization of the femoral calcar with a cable proximal to the lesser trochanter. Fluoroscopic control and evaluation of implant positioning. Percutaneous distal screw fixation with minimally enlarged access. Full weight-bearing and immediate rehabilitation protocol. DETAILED CONTENT Structured Surgical Planning: Definition of the operative strategy based on preoperative fluoroscopic images, evaluation of the cemented component's stability, and planning the fixation sequence without prosthetic revision. Re-approach through the Postero-lateral Approach: Technique for re-identifying anatomical planes in a fibrotic field using the posterior superior iliac spine as a continuous reference, with the limb positioned at 45° flexion for secure diaphyseal alignment. Anatomical Exposure in a Fibrotic Field: Strategies for dissection in anatomy altered by previous surgery, with identification of the iliotibial tract, fascia lata, and remaining sutures of the external rotators, preserving muscular and vascular structures. Proximal Anchorage via Transtendinous Portals: Creation of portals in the gluteus medius and gluteus minimus tendons for positioning the proximal end of the trochanteric plate directly over the bone, avoiding fluctuation with soft tissues. Selection and Passage of Perifemoral Cables: Practical criteria for choosing the cable passer's radius of curvature according to the femoral diaphysis's diameter, minimizing muscle trauma and ensuring a smooth path against the bone for efficient tightening. Torque Control in Osteoporotic Bone: Progressive tactile approach for tightening cables in bone with low mineral density, preventing cortical fracture due to overload and ensuring firm fixation with continuous fluoroscopic control. Fixation with Screw in Oval Hole: Use of a directional cortical screw in the plate's oval hole to precisely bypass the cemented femoral component, adding significant stability to the final assembly. Stabilization of the Femoral Calcar: Positioning of a cable proximal to the lesser trochanter for fixation of the femoral calcar, with an alternative strategy through the superior region of the plate when direct access to the intended level is anatomically limited. Percutaneous Distal Screw Fixation: Placement of the distal screw with minimal enlargement of the access, using digital palpation as a guide for precise positioning and reduction of additional surgical trauma. Fluoroscopic Evaluation and Final Result: Intraoperative confirmation of ideal implant positioning with three cables superior to the fracture, trochanteric screw, and hook anchorage, validating mechanical stability for immediate full weight-bearing. MATERIAL INCLUDED Detailed PDF: The PDF presents a complete analysis of periprosthetic hip fracture, classification and decision-making criteria for fixation without prosthetic revision, sequence of operative steps, biomechanical principles of hybrid fixation with trochanteric plate, cables and screws, re-approach strategies in fibrotic field, torque control in osteoporotic bone, and rehabilitation protocol with immediate postoperative full weight-bearing.