168 Interprosthetic Fractures of The Femur: A Literature Review

Abstract

Abstract Increasing age expectations and number of joint replacement procedures have made interprosthetic femoral fractures (IFF) a progressively more common diagnosis and a challenge for surgeons. A gold standard and universally accepted classifications and guidelines do not exist yet. Customized structured electronic searches performed in PubMed database. Relevant key terms: IFF, classification interprosthetic fracture, peri-implant femoral fracture, biomechanics interprosthetic femur fracture, radiographic femur fracture, risk factor IFF. 42 articles finally included (up to 2019). High morbidity and mortality linked to IFF. Standardised classifications, management guidelines and surgical approaches are not available yet. Periprosthetic classification systems are still utilized even if not entirely appropriate. High rate of failure is related to thinner cortical bone, larger medullary canals and variable stresses depending on the distance among implants. High complication rates in all studies. Stress risers and implant stability based on fracture patterns and stress forces. Several surgical options with no uniformity. Less invasive surgical procedures are associated to reduction of metalwork failure rate, better preservation of vascularization and better functional-clinical outcomes. Lack of specific classification systems and management guidelines. Several surgical options are available with no uniformity of results. Attention to stress risers and preservation of bone stock and vascularization are key aspects for better results.