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Z Orthop Unfall 2024; 162(04): 349-359
DOI: 10.1055/a-2051-8613
Review

Intraoperative Periprosthetic Femur Fracture - When is the Cerclage Enough?

Article in several languages: English | deutsch
Sebastian Hardt
1   Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Deutschland (Ringgold ID: RIN14903)
,
Gregor Giebel
1   Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Deutschland (Ringgold ID: RIN14903)
,
Robert Hube
2   Orthopädische Chirurgie, OCM-Klinik München, München, Deutschland
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Abstract

Background and Planning Intraoperative periprosthetic femoral fractures are among the most serious complications in both primary and revision arthroplasty. They are often not detected, despite intraoperative radiological control. Since an unnoticed intraoperative fracture often requires revision surgery, which has been associated with increased mortality rates, intraoperative diagnosis and corresponding direct and sufficient treatment are crucial. There are patient-, surgery-, and implant-specific risk factors that increase the possibilities of intraoperative fractures. The most common risk factors on the patient side are age, gender, and various pre-existing conditions, such as osteoporosis or rheumatic diseases. A minimally invasive approach and a cementless press-fit fixation are the most significant surgery- and implant-specific risk factors. The Vancouver classification or the modified Mallory classification are available for the classification of intraoperative periprosthetic femoral fractures. Based on these classifications, treatment recommendations can be derived. Different strategies are available for fracture management.

Therapy Generally, if the stem is stable, osteosynthesis can be performed with preservation of the implant. This procedure can be applied to the majority of cases with non-displaced fractures by using cerclages as fixation. An unstable implant may require replacement of the stem. In higher grade fractures, stabilisation by using plate osteosynthesis may be necessary. The aim is to achieve the most anatomical reposition possible for the best possible bony consolidation. The ultimate goal is high implant stability and restoration of the biomechanics.

Keywords

periprosthetic femur fracture - revision hip arthroplasty - cerclage - intraoperative femur fracture - stem stability


Publication History

Received: 22 November 2022

Accepted after revision: 07 March 2023

Article published online:
29 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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