Abstract
Prevention: Many periprosthetic femur fractures may be prevented by: (1) good patient follow-up, (2) timely reoperation of lytic lesions if radiographs suggest fracture risk, and (3) prophylactic use of longer stemmed implants or strut grafts to bypass cortical defects at revision surgery.
Treatment: Periprosthetic fractures can be treated using an algorithmic approach based on the Vancouver classification system. Fractures of greater or lesser trochanter (Type A)
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Nonoperative treatment if displacement acceptable and if not associated with lysis
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Operative treatment if displacement unacceptable or associated with progressive lysis Fractures of distal femur well distal to implant (Type C)
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Treat as any other femur fracture, usually operatively
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Fixation options: plate/retrograde nails Fractures around the implant or at its tips (Type B)
These fractures almost always require surgery. Nonoperative treatment is associated with high rate of malunion, nonunion, poor results. Treatment is according to fixation status of implant and bone quality.
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Well-fixed stem (Type B1): ORIF with cable plate and/or strut grafts
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Loose stem, reconstructable bone (Type B2): revise implant to long stem; usually use uncemented, distally fixed implant; occasionally long cemented stem (avoid cement extrusion)
* Principles: obtain fracture stability, implant stability, and optimise conditions for bone healing (use bone grafts, don’t strip periosteum)
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Loose stem, unreconstructable proximal bone damage (Type B3): revise substituting for proximal femur with allograft prosthetic composite or tumour prosthesis
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
