Peri- and Interprosthetic Femoral Fractures—Current Concepts and New Developments for Internal Fixation

Abstract

Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal fixation of periprosthetic fractures. Since the elderly are unable to follow partial weight bearing, stable solutions are required. Therefore, a high primary stability is necessary. Numerous options, such as new angular stable plate systems with additional options for variable angle screw positioning, already exist and are in the process of being further improved. Lately, individually produced custom-made implants are offering interesting alternatives to treat periprosthetic fractures.

Risk of Interprosthetic Femur Fracture Is Associated with Implant Spacing—A Biomechanical Study

“…Patients are postoperatively advised to bear their full weight if tolerated after 2 to 4 months, which increases the bending load on the femur. Thus, a higher load for the test setup seems more suitable [6,21]. Weiser et al also demonstrated the importance of cortical thickness but rejected a critical effect of interprosthetic distance on strain amplification between implants [22].…”

“…The most common reasons for revision surgery are infection, implant loosening or periprosthetic fractures [3][4][5]. Revision surgery of hip and knee arthroplasty is often associated with longer anchoring stems and requires significant surgical expertise [6,7]. Problems arise in patients with ipsilateral adjacent hip and knee implants with only a short residual length between implants.…”