Treatment aspects of interprosthetic femur fractures-retrospective analysis of 70patients

Abstract

Interprosthetic femur fractures (IFF) are rare injuries, whose surgical treatment is basically with osteosynthesis or revision arthroplasty. Various therapy algorithms have been proposed based on very small study collectives. Factors influencing the outcome are not known. The aim of the retrospective monocentric study is to derive atreatment algorithm based on alarge number of cases and to identify factors influencing the outcome. Between 2006 and 2020, 70IFF were identified. The surgical treatment comprised 38osteosyntheses, 30revision arthroplasties and 2amputations. With classification and time to surgery, 69perioperative variables were recorded. General and operative complications, as well as mortality, were determined in the follow-up period of 1 year. ASA and Charlson score correlated with 1‑year-mortality. In addition, preoperatively increased CRP levels, reduced hemoglobin and the CHA2DS2-VASc score were identified as factors influencing mortality. Surgery within 24 h showed atrend towards fewer general complications. Transferred patients indicated an increased mortality. Based on classification according to Pires etal. or Füchtmeier etal. no clear treatment decision could be made. Relevant criteria for the surgical treatment were fracture localization, implant stability, bone vitality, anchoring possibility of the revision stem, as well as general condition of the patient. The identified factors influencing the outcome correspond to those of patients with hip fractures. IFF should be treated timely. Atreatment path was developed on the basis of the largest patient group to date.