Abstract
Concepts of intramedullary stabilization of femoral fractures include reconstruction of length, axis and rotation rather than meticulous reduction of the fragments and minimal impact on fragment vascularization by the surgical approach. Those keys to success can be transferred to the treatment of periprosthetic fractures. An interlocked uncemented revision stem is used; this implant can be regarded as a combination of an interlocking nail in its distal part and a proximally coated femoral stem in its proximal part. The transfemoral approach respects the vascularization of the bone, although it is not minimal-invasive. Distal load transfer is necessary during proximal bone healing, but it can be switched to proximal load transfer by removal of the interlocking screws. Results of a multicentric study including 50 cases demonstrate undisturbed bone healing and a significant regain of deficient proximal bone stock. Survival in another series of 109 revision cases was 85.3% after 7 years. In conclusion, the combined application of principles of intramedullary nailing and of uncemented total hip replacement enables the successful treatment of periprosthetic femoral fractures.
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