Periprosthetic femoral fractures:: Treatment and results in 51 cases

Periprosthetic femoral fractures present the problem of fracture treatment and prosthetic stability. Various treatment options are recommended for managing these fractures. We treated 51 patients with 54 periprosthetic fractures between 1985 and 1995. Of these, 42 (78 %) fractures were treated with a plate, eight (14 %), with a revision prosthesis, two (4 %), with retrograde nailing, and two (4 %), conservatively due to poor medical condition. The choice of fracture management was dependent on the type and location of the fracture and on the stability of the prosthesis. A total of 50 fractures healed primarily. Complications included th ree cases of plate loosening, one further fracture, one deep infection, one broken bolt and one varus deformity. Four patients died in the postoperative period, an additional 19 were dead at the time of the evaluation. Fractures with a stable implant can be treated with plate fixation. Cases of a loose implant require revision. Distal fractures are stabilized with a plate or with a retrograde nail.