The management of proximal periprosthetic femoral fractures: Is open reduction and internal fixation a solution for all fractures treated surgically around a polished tapered stem?

Abstract

The aim of this study is to assess whether open reduction and internal fixation (ORIF) is appropriate for the surgical management of all proximal femoral periprosthetic fractures involving a polished tapered stem. This retrospective case series assessed the five year follow-up of 105 consecutive patients treated with ORIF following proximal femoral periprosthetic fractures with minimum 12-month follow-up. Primary outcome measure of this study was union at one year following surgery and secondary outcome measures included reoperation, post-operative infection and dislocation. 105 patients had periprosthetic fractures over 10 years (B1 n = 31; B2 n = 64; and C n = 10). Union within one year of periprosthetic fractures were achieved in 76.7 % of short oblique/transverse fractures and 100 % of long spiral fractures. The fracture pattern and fracture location with B1, B2 and C type were disturbed in a statistically significant pattern. Importantly, each periprosthetic fractures that did not achieve union by one year resulted in plate breakage which resulted in further major revision surgery. We advocate that ORIF should be attempted in all proximal femoral periprosthetic fractures as only a small number of patients develop non-union and go on to require further surgery. Short oblique fractures at the tip of the stem are higher risk for non-union and dual plating could be considered in these cases.