Retrospective study of management and outcome of periprosthetic femoral fractures, in a lower limb reconstruction, reference centre. 144 fractures over a period of 20 years were reviewed. The Vancouver system was used to classify the fractures. The prosthesis length was measured pre and post operatively. The use of impaction grafting technique to compensate for inadequate bone quality of the surrounding bone was assessed (type B3 fractures). The use of Dall/ Miles, DCP and Mennen plates also assessed. Healing was defined using radiological and clinical criteria. Chi-square test with p<
0.05 was used for the analysis of the results. When the Vancouver system was applied 2.85% of the fractures were classified as type A, 87.2% as type B and 10% as type C. Within type B group 13.2% were subtype B1, 12% subtype B2 and 62% subtype B3. Better healing achieved when the revision stem was bypassing the most distal fracture line (p=0.005). Better healing achieved when impaction grafting was used for B3 fractures (p=0,0001). 1 out of 6 Mennen, 4 out of 16 Dall/Miles and 2 out of 20 DCP plates used failed. Overall 68% healing, 5% non-union, 1% infection, 24% re-fracture rate at 12 months follow up. Impaction grafting could compensate for the inadequate bone in type B3 fractures. Revision stem should bypass the most distal fracture line to achieve healing. DCP plates do better than Dall/Miles. Mennen plates have got special indications.
