Concepts and potential future developments for treatment of periprotethic proximal femoral fractures

Periprosthetic proximal femoral fractures are a major challenge for the orthopedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Taking into account the presence of an intraosseous implant, we chose the tactics of surgical intervention using techniques that allow rigid fixation of the fragments of a periprosthetic fracture, which creates uniform compression around the stem of the endoprosthesis, which reduces the risk of loosening of the joint components in the interoperative and postoperative period: a technique with the use of a special plate.