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Background <p>Plate fixation for Vancouver type C periprosthetic femoral fractures presents a surgical challenge, and nonunion is a serious complication. The relationship between specific fixation constructs and fracture healing remains poorly understood. This study aimed to describe the radiographic characteristics of patients with nonunion following plate fixation for these fractures, with a focus on proximal fixation strategies.</p> Methods <p>This multicenter retrospective study included 18 patients who underwent plate osteosynthesis for Vancouver type C fractures between 2014 and 2022. Patients were divided into union and nonunion groups based on fracture healing at 12 months postoperatively. We analyzed postoperative radiographs to compare patient demographics and the number and type of fixation devices (screws and wires) used for the proximal fragment between the two groups.</p> Results <p>Nonunion occurred in 5 of 18 patients (27.8%). There were no significant differences in patient baseline characteristics between the groups, except for BMI. Radiographically, the nonunion group had a significantly greater total number of proximal screws (median, 6 vs. 3; <i>p</i> = 0.035) and proximal monocortical screws (median, 6 vs. 2; <i>p</i> = 0.049) than the union group. The total number of proximal fixation devices (screws plus wires) was also significantly greater in the nonunion group (median, 8 vs. 6; <i>p</i> = 0.029). Receiver operating curve analysis revealed a cutoff value of 5 total number of proximal screws for predicting nonunion (area under the curve [AUC], 0.831).</p> Conclusion <p>A greater number of proximal fixation devices, particularly monocortical screws, is a distinct radiographic parameter associated with nonunion in Vancouver type C fractures treated with plating. This finding may not be a causative factor but rather an indicator of initial technical difficulty and fixation instability. When extensive proximal fixation is required, surgeons should consider adjunctive stabilization techniques to improve outcomes.</p>

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Radiographic parameters of nonunion in Vancouver type C periprosthetic femoral fractures treated with plate fixation

  • 期刊论文

  • 发表日期：

    2025年10月29日

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  • Shimpei Takahashi,
  • Yasuhiko Takegami,
  • Hiroaki Nakashima,
  • Kenichi Mishima,
  • Toshiki Iwase,
  • Shiro Imagama

摘要

Background

Plate fixation for Vancouver type C periprosthetic femoral fractures presents a surgical challenge, and nonunion is a serious complication. The relationship between specific fixation constructs and fracture healing remains poorly understood. This study aimed to describe the radiographic characteristics of patients with nonunion following plate fixation for these fractures, with a focus on proximal fixation strategies.

Methods

This multicenter retrospective study included 18 patients who underwent plate osteosynthesis for Vancouver type C fractures between 2014 and 2022. Patients were divided into union and nonunion groups based on fracture healing at 12 months postoperatively. We analyzed postoperative radiographs to compare patient demographics and the number and type of fixation devices (screws and wires) used for the proximal fragment between the two groups.

Results

Nonunion occurred in 5 of 18 patients (27.8%). There were no significant differences in patient baseline characteristics between the groups, except for BMI. Radiographically, the nonunion group had a significantly greater total number of proximal screws (median, 6 vs. 3; p = 0.035) and proximal monocortical screws (median, 6 vs. 2; p = 0.049) than the union group. The total number of proximal fixation devices (screws plus wires) was also significantly greater in the nonunion group (median, 8 vs. 6; p = 0.029). Receiver operating curve analysis revealed a cutoff value of 5 total number of proximal screws for predicting nonunion (area under the curve [AUC], 0.831).

Conclusion

A greater number of proximal fixation devices, particularly monocortical screws, is a distinct radiographic parameter associated with nonunion in Vancouver type C fractures treated with plating. This finding may not be a causative factor but rather an indicator of initial technical difficulty and fixation instability. When extensive proximal fixation is required, surgeons should consider adjunctive stabilization techniques to improve outcomes.