To the Editor:

We read the article by Weinrauch and Krikler (1) with interest and we would like to present to your readers an alternative method of fixation for this fracture that we have found useful in two similar instances.

Two male patients in their 50's sustained proximal femoral fractures below a resurfacing arthroplasty. One injury was a simple intertrochanteric fracture but the second involved a mutifragmented pattern with a reverse oblique element. Both of these were successfully fixed with a non- contact bridging(NCB)locking plate(Zimmer)with variable axis screws into the femoral neck. Although this plate is designed to fix distal femoral fractures, we have found that by reversing the plate it provides a good purchase when treating femoral neck fractures. A further benefit of this device is that the variable axis screws into the femoral neck allow a good hold adjacent to the stem of the femoral component.

There is very little published literature on how to deal with this injury and we expect similar fractures to occur more frequently as resurfacing arthoplasty becomes more common. We hope that by reporting such methods of fixation, we will provide good options for those who have to deal with this injury in the future.

References:

1. Patrick Weinrauch and Steve Krikler Proximal Femoral Fracture After Hip Resurfacing Managed with Blade-Plate Fixation. A Case Report J Bone Joint Surg Am 2008; 90: 1345-1347

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.