Introduction

Successful fixation of the greater trochanter in total hip arthroplasty poses a significant challenge with varied clinical outcomes reported despite advancements in fixation technology, especially in cases involving patients with poor bone quality or small fracture fragments, such as those classified as Vancouver A fractures. This study aimed to evaluate nonunion and reoperation rates following trochanteric plate fixation, comparing claw plate to locking plate methods.

Methods

A retrospective review of 87 patients with periprosthetic greater trochanter fractures in primary and revision total hip arthroplasty from 2014-2023 was conducted. Initial injury, immediate, and final follow-up radiographs were assessed. Primary outcomes included fracture healing rate, reoperation rate, and mortality rates.

Results

Of the 87 patients (mean age 73.0 years, 62.1% female), 50 (57.5%) underwent claw plate fixation and 37 (42.5%) underwent locking plate fixation. 52.3% of periprosthetic fractures occurred in primary hip arthroplasties and 47.7% in revision hip arthroplasties, with 40% classified as Vancouver A and 19.5% as Vancouver B2 fractures. At a mean follow-up of 1.8 years, no significant differences were observed in the rate of fibrous union (14.9% claw vs 6.9% locking) (p=0.275). However, the rate of osseous union was significantly higher among patients who underwent locking plate fixation (31% claw vs. 34.5% locking) (p=0.009) and the nonunion rates were significantly higher with claw plate fixation (11.5%) compared to locking plate fixation (1.1%) (p=0.016). 

Conclusion

Fixation of trochanteric fractures remains a challenge in total hip arthroplasty as evidenced by a high incidence of nonunion rate and reoperation in this large series. Claw plate fixation demonstrated significantly higher nonunion rates, suggesting potential limitations of this approach in certain patient populations.