[Interprosthetic femoral fractures : Osteosynthesis, megaendoprosthesis, limb salvage?]

Abstract

Interprosthetic femoral fractures (IFF) involve fractures occurring between total hip and knee arthroplasty and represent an increasing challenge, with complication rates of up to 57% and a mortality rate of 31%. The treatment is complex and requires an individual, often multidisciplinary approach. Risk factors are related to the patient, implant and surgical technique. Classification systems, such as the one proposed by Pires enable a systematic categorization based on fracture location and morphological features of the fracture. The treatment options range from angular stable plate osteosynthesis, double plate fixation and nail-plate combinations to endoprosthetic solutions, such as stem revision, proximal or distal femur replacement or total femur replacement (TFR). As an alternative to TFR, sleeves can be used providing a bone-sparing solution. Endoprosthetic procedures are primarily indicated for loose prostheses and poor bone quality but carry a higher risk of complications. The choice of treatment depends on many factors, especially fracture type, prosthesis fixation and bone vitality. The goal is always an early functional, loadbearing reconstruction to prevent secondary complications. Preventively, attention should be paid to the biomechanically adapted and stable treatment of the primary arthroplasty. Ultimately, IFFs require detailed planning and expertise in both osteosynthetic and endoprosthetic treatment strategies.