Treatment Algorithm of Periprosthetic Femoral Fracturens

Autor: Nicola Mondanelli MD, PhD, Elisa Troiano MD, Andrea Facchini MD, Roberta Ghezzi MD, Martina Di Meglio MD, Nicolò Nuvoli MD, Giacomo Peri MD, Pietro Aiuto MD, Giovanni Battista Colasanti MD, Stefano Giannotti MD
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Geriatric Orthopaedic Surgery & Rehabilitation, Vol 13 (2022)
Druh dokumentu: article
ISSN: 2151-4593
21514593
DOI: 10.1177/21514593221097608
Popis: Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients’ functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients’ early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the “real” level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.
Databáze: Directory of Open Access Journals
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