Periprosthetic Femoral Fracture

Abstract

The treatment of periprosthetic fractures requires competence, not just in osteosynthetic techniques, but also in endoprosthesis implantation and revision. Careful preoperative planning to select the proper treatment is essential, and the necessary equipment must be on hand.

The Biological Metallic versus Metallic Solution in Treating Periprosthetic Femoral Fractures: Outcome Assessment

“…The nailing is also not recommended in the presence of ipsilateral hip replacement since it creates a less resistant area between the stems of the two implants such as causing a fracture in the free interposed zone. The osteosynthesis with plate is primarily recommended in comminuted fractures of the more distal portion of the femur on stable implants (Type 2 Rorabeck), where the construct with multiple converging screws with angular stability provides mechanical stability to the axial and torsional forces acting on bones often osteoporotic [27]. The development of plates with polyaxial screws also allows insertion of screws around any prosthetic implant.…”

“…The development of plates with polyaxial screws also allows insertion of screws around any prosthetic implant. Many authors consider useful, especially in highly comminuted fractures, the use of such plates with angular stability with bridge fittings, bypassing the fracture, as long as a correct axial alignment is guaranteed [27]. When possible, the use of LISS plate (Less Invasive Stabilization System) with minimally invasive MIPO technique (Minimally Invasive Plate Osteosynthesis) allows a minimal dissection of the soft tissue and periosteum, reduced blood loss, and reduced risk of infection [27].…”

“…Many authors consider useful, especially in highly comminuted fractures, the use of such plates with angular stability with bridge fittings, bypassing the fracture, as long as a correct axial alignment is guaranteed [27]. When possible, the use of LISS plate (Less Invasive Stabilization System) with minimally invasive MIPO technique (Minimally Invasive Plate Osteosynthesis) allows a minimal dissection of the soft tissue and periosteum, reduced blood loss, and reduced risk of infection [27]. The plate osteosynthesis is especially useful in the presence of an implant in the proximal femur (prosthetic rod or pertrochanteric nail) being equipped with monocortical stability screws that permit overlap pin of the distal portion of the implant, so as to avoid an increase of stress between two implants.…”

“…The plate osteosynthesis is especially useful in the presence of an implant in the proximal femur (prosthetic rod or pertrochanteric nail) being equipped with monocortical stability screws that permit overlap pin of the distal portion of the implant, so as to avoid an increase of stress between two implants. Ultimately a stable internal fixation with a reduced damage to soft tissues allows an early functional recovery [27]. The use of the plate and the graft of allogenic femoral cortical splint in the treatment of periprosthetic femoral fractures is not a new technique and it has been extensively described by many authors [28].…”

Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates

“…Thus, a precise assessment of the fracture pattern, as well as a proper pre-operative planning of the type of reconstruction (osteosynthesis versus revision arthroplasty), is indispensable. On account of this, treatment strategies have been developed following distinct algorithms with the goal to regain function at the level prior to the trauma [6][7][8]. Epidemiological data has shown, that the majority (75 %) of PPF occur at the tip of a well-fixed stem (Vancouver B1 according to Duncan and Masri [9]), thereby being appropriate for osteosynthetic stabilisation [10].…”