| Abstrakt: |
Periprosthetic fractures are becoming increasingly common nowadays. Standard treatment includes revision of the prosthetic implant, albeit this option typically leads to complex and lengthy interventions. Removal of the prosthesis often leads to significant bleeding, which has particular relevance for elderly subjects with significant comorbidities. Osteosynthesis using plates or nails is the second choice, albeit limitedly to the femoral portion, as it may not be used in the tibial portion. Our experience has prompted us to use LISS plates for fracture reduction, which allows for better management of complex, multifragmentary fractures, even in proximity to the prosthetic implant. Retrograde nailing is not always feasible due to a number of factors, such as: type of prosthesis, presence of fragments near the prosthetic implant, loss of bone material. An increase in the incidence of fractures between the prosthetic stem and intramedullary nails has been observed. The use of nails is preferred thanks to the shorter surgical times in case of uncomplicated fractures. On the other hand, plates allow for fracture stabilisation, especially with distal fractures, with the restoration of limb length without any need for lengthy incisions or damage to periskeletal soft tissues and minimum risk of perioperative bleeding (better patients compliance). Furthermore, they allow for better control of possible axial deviations of the segment, even in case of rotary movements (not always fixed by the application of retrograde nails). On the basis of published evidence, the use of plates seems to be preferable over nailing. Lastly, there is the need to emphasise that attentive and diligent surgical techniques at the time of the prosthetic implant largely reduces the incidence of such fractures. [ABSTRACT FROM AUTHOR] |
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