Periprosthetic Femur Fractures: The Screw-In-Washer Technique for Bicortical Small-Fragment Screw Fixation Through Large-Fragment Plates. A Technical Trick and Case Series

Summary: When treating periprosthetic femur fractures, bicortical screw fixation around a medullary-filling femoral stem may present a technical challenge, potentially leading surgeons to opt for unicortical locking screws or cerclage wires. These solutions may not achieve desirable stability, particularly in osteoporotic bone. In this technical note, we describe a simple approach using bicortical small-fragment screws-in-washers through large-fragment plates to facilitate secure bicortical screw passage around the stem. We also present preliminary outcomes from a case series in which this technique was used.