title: Intraoperative Periprosthetic Fractures in Proximal Interphalangeal Joint Arthroplasty.
abstract: OBJECTIVE
  To examine the frequency, risk factors, and postoperative outcomes associated with intraoperative periprosthetic fractures during proximal interphalangeal (PIP) joint arthroplasty.
  
  
  METHODS
  We examined 382 consecutive PIP joint arthroplasties in 205 patients. Procedures were performed from 1998 to 2012. The patients were identified and outcomes were collected through a single institution's total joints registry, collecting additional information not contained in the prospectively collected registry through medical record examination. Multiple outcomes were analyzed relating to the fractures, the hard surgical outcomes, finger function, and radiographic findings. Statistical analysis was performed utilizing Kaplan-Meier survival models, log-rank tests, univariate analysis, Student t test and Fisher exact test.
  
  
  RESULTS
  Intraoperative periprosthetic fracture occurred in 5% (n = 20) of 383 PIP joint arthroplasties. All of the patients who had an intraoperative fracture were women. Lower body mass index and a diagnosis of rheumatoid arthritis were associated with a significantly higher risk of intraoperative fracture. The use of pyrocarbon implants also significantly increased fracture risk. At a median follow-up of 5.3 years, there were no refractures in the patients who sustained an intraoperative fracture. Six patients underwent revision surgery, with a 2- and 5-year survival rate free of revision surgery of 76% and 64%, respectively. These rates were not significantly different from those without intraoperative fractures. There was no significant difference in the incidence of postoperative complications between patients with or without an intraoperative fracture.
  
  
  CONCLUSIONS
  Intraoperative fractures occur in about 5% of PIP joint arthroplasties. These periprosthetic fractures do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications. Female sex, lower body mass index, rheumatoid arthritis, and the use of pyrocarbon implants were associated with increased risk for intraoperative fractures.
  
  
  CONCLUSIONS
  This information may help decrease fracture risk and help surgeons identify and treat the fractures when they do occur.
  
  
  METHODS
  Prognostic II.
authors: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
authors: Eric R
authors: ER
authors: Wagner
authors: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
authors: Robert
authors: R
authors: Van Demark
authors: Department of Anesthesiology, Mayo Clinic, Rochester, MN.
authors: Daryl J
authors: DJ
authors: Kor
authors: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
authors: Steven L
authors: SL
authors: Moran
authors: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN. Electronic address: rizzo.marco@mayo.edu.
authors: Marco
authors: M
authors: Rizzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050806:Arthroplasty, Replacement, Finger / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000453:epidemiology* / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Proximal interphalangeal joint arthroplasty; intraoperative fracture