title: [Principles of management of periprosthetic fractures].
abstract: BACKGROUND
  The increasing numbers of primary total hip and knee replacements have subsequently led to growing rates of periprosthetic fractures. In many cases geriatric patients with osteopenia or osteoporotic bone quality are affected. The goal of treatment is the retention or reconstruction of joint function using open reduction and internal fixation or a revision prosthesis.
  
  
  OBJECTIVE
  The aim of this article is a description of the basic principles of treatment of periprosthetic fractures of the lower extremities.
  
  
  METHODS
  An exact description of the fracture using current classification systems with imaging diagnostics is mandatory. This also includes an assessment of the stability of the prosthesis. In the case of a stable prosthesis and a good bone stock open reduction and internal fixation should be performed. In these cases locking plates are standard procedure. If fracture reduction is possible minimally invasive procedures can be performed which help to reduce the surgical trauma and accelerate rehabilitation. If the prosthesis is loose it has to be exchanged for a revision implant. If vast bony defects result they can be augmented using wedges. Conservative treatment plays only a subordinate role in selected cases.
  
  
  CONCLUSIONS
  Periprosthetic fractures show an increasing incidence and occur more frequently in the geriatric patient population. Due to comorbidities and poor bone quality surgical treatment is a challenge. The fracture must be exactly classified using the appropriate classification system in order to clarify if the prosthesis can be retained or if it has to be exchanged.
authors.affiliation: Zentrum für Chirurgie, Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland. goetz.roederer@uniklinik-ulm.de.
authors.forename: G
authors.initials: G
authors.lastname: Röderer
authors.affiliation: Zentrum für Chirurgie, Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Gebhard
authors.affiliation: Zentrum für Chirurgie, Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Scola
mesh_terms: D000072700:Conservative Treatment / Q000379:methods; D019317:Evidence-Based Medicine; D005593:Fracture Fixation, Internal / Q000379:methods* / Q000534:rehabilitation; D017102:Fracture Healing; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D000070799:Open Fracture Reduction / Q000295:instrumentation / Q000379:methods* / Q000534:rehabilitation*; D057068:Periprosthetic Fractures / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome
keywords: Angular stability; Classification; Fracture; Prosthesis; Revision prosthesis