title: Operative management of periprosthetic femur fractures in the elderly using biological fracture reduction and fixation techniques.
abstract: Treatment of periprosthetic femur fractures often requires deviation from standard fixation techniques due to the presence of associated arthroplasty components, however, the use of adjuvant bone grafts and bone graft substitutes remain controversial. 59 patients (average age, 74 years) with either a periprosthetic femoral shaft about an arthroplasty stem (n=29) or supracondylar fracture above a total knee arthroplasty (n=30) were treated with biological open-reduction internal-fixation techniques without the use of bone grafts or bone-graft substitutes. All except one patient healed after the index procedure. Three patients had progressive malalignment associated with failed screw fixation but all healed without further surgical intervention. 49 out of the 59 patients returned to their baseline level of function. These results indicate that use of adjuvant bone graft materials may not be routinely necessary when treating periprosthetic femur fractures using lateral plates and biological reduction and fixation techniques.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA. ricciw@wudosis.wustl.edu
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
authors.forename: Joseph
authors.initials: J
authors.lastname: Borrelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006620:Hip Fractures / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome