Hook plate fixation and the importance of anatomical reduction in periprosthetic hip fractures: a retrospective single-centre study at a United Kingdom District General Hospital.

backgroundPeriprosthetic hip fractures are an increasingly common consequence of the expanding arthroplasty population and are associated with substantial morbidity, mortality, and technical operative complexity. Evidence evaluating hook plate fixation in routine district general hospital practice remains limited. This study evaluated outcomes following open reduction and internal fixation (ORIF) of periprosthetic hip fractures, with particular emphasis on fracture reduction quality and fixation outcomes.

methodsA retrospective single-centre cohort study was conducted including consecutive patients undergoing ORIF for periprosthetic hip fractures between January 2021 and November 2023 at a UK district general hospital. Patients treated using either a GTR Cable Ready trochanteric hook plate or a Non-Contact Bridging (NCB) periprosthetic locking plate were included. Demographic characteristics, fracture classification, operative variables, complications, mortality, radiographic union, and functional status were analysed. Anatomical reduction was defined as residual displacement ≤ 2 mm with at least 50% cortical contact on post-operative radiographs. Statistical analysis was performed using Fisher's exact testing and non-parametric comparative methods.

resultsThirty-six patients met inclusion criteria, with a mean age of 84.4 years; 63.9% were female. Vancouver B1 fractures accounted for 75.0% of cases. Twenty-four patients underwent hook plate fixation and 12 underwent NCB plate fixation. Anatomical reduction was achieved in 30 patients (83.3%). Patients with non-anatomical reduction experienced significantly higher complication rates than those achieving anatomical alignment (83.3% versus 26.7%, p = 0.016). Non-B1 fractures were also associated with higher complication rates compared with B1 fractures (66.7% versus 25.9%, p = 0.046). Overall hardware failure occurred in 11.1% of patients and revision surgery in 8.3%. Thirty-day mortality was 8.3%, and overall mortality during follow-up was 19.4%. Confirmed radiographic union was documented in 50.0% of patients at a mean of 6.6 months. Functional mobility significantly deteriorated following surgery (p = 0.0025). Construct-specific comparisons did not demonstrate statistically significant differences; however, these analyses were underpowered and descriptive.

conclusionsPeriprosthetic hip fractures represent a complex injury in a frail and elderly population. Anatomical fracture reduction emerged as the most clinically important modifiable factor associated with post-operative complications. These findings support careful pre-operative planning, appropriate construct selection, objective radiographic assessment of reduction quality, and structured multidisciplinary periprosthetic fracture pathways. The study should be interpreted as real-world evidence from routine district general hospital practice rather than as a definitive comparison between fixation constructs.