[Peri-implant shaft fractures of the femur and tibia : Classification, diagnostics, treatment and geriatric trauma aspects].

Abstract

Peri-implant fractures of the femur and tibia shaft represent an increasing challenge in the clinical routine due to rising incidence, an aging and multimorbid patient population and often unfavorable postoperative outcomes. This article provides an overview of classification systems, diagnostic approaches and therapeutic strategies, with particular emphasis on aspects relevant to geriatric trauma care. The Vancouver, Lewis-Rorabeck, and Felix classifications form the basis for making treatment decisions in periprosthetic fractures of the femur and tibia. The management is primarily guided by the fracture location, implant stability, and bone quality. In cases of stable implants, locking plate osteosynthesis or intramedullary nailing is commonly used. When prosthetic loosening is present (e.g., Vancouver B2/B3 or Lewis-Rorabeck type III classification), revision arthroplasty is generally required. Interprosthetic fractures represent a distinct biomechanical challenge due to the presence of the implant and necessitate lengthy, locking bridging constructs or, in selected cases, the use of a megaprosthesis. In the context of geriatric trauma care, early mobilization that enables immediate full weight-bearing and interdisciplinary treatment within a certified geriatric trauma center are essential to reduce morbidity, mortality and the level of long-term care needed. Furthermore, the use of cemented stems can reduce the risk of periprosthetic proximal femoral fractures. These aspects should be incorporated into the management of geriatric trauma patients to contribute to an improvement in long-term outcomes.