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
