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Review
. 2022 Mar 2;11(5):1371.
doi: 10.3390/jcm11051371.

Peri- and Interprosthetic Femoral Fractures-Current Concepts and New Developments for Internal Fixation

Clemens Kösters  1 , Daniel den Toom  1 , Sebastian Metzlaff  2 , Kiriakos Daniilidis  3 , Linda Barz  1 , Steffen Roßlenbroich  4
Affiliations
Review

Peri- and Interprosthetic Femoral Fractures-Current Concepts and New Developments for Internal Fixation

Clemens Kösters et al. J Clin Med. .

Abstract

Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal fixation of periprosthetic fractures. Since the elderly are unable to follow partial weight bearing, stable solutions are required. Therefore, a high primary stability is necessary. Numerous options, such as new angular stable plate systems with additional options for variable angle screw positioning, already exist and are in the process of being further improved. Lately, individually produced custom-made implants are offering interesting alternatives to treat periprosthetic fractures.

Keywords: current concepts; elderly patients; periprosthetic fractures; plate osteosynthesis.

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Conflict of interest statement

C.K. and S.M. are medical advisors for aap Implantate AG, Berlin, Germany. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The 3.5/4.5 Variable Angle LCP® Periprosthetic Proximal Femur Plating System by Depuy-Synthes from [20]. (Reprinted with permission from [20] 2021 Depuy-Synthes).
Figure 2
Figure 2
Distal and proximal plates of the EVOS Large & Periprosthetic Plating System by Smith & Nephew.
Figure 3
Figure 3
(a) LOQTEQ VA Periprosthetic Plate (with kind permission of aap Implantate AG, Berlin, Germany). (b) Insertable hinge with each of the two variable angle screw options (with kind permission of aap Implantate AG, Berlin, Germany). (c) Periprosthetic fracture around a cemented stable total hip revision arthroplasty. (d) LOQTEQ VA Periprosthetic Plate with mounted aiming device. (e) LOQTEQ VA Periprosthetic Plate with four inserted hinges. (f) Variable angle screw placement around the hip revision stem. (g) Postoperative X-rays. Four hinges with each of the two variable angle screw options were used to fix the plate around the hip stem.
Figure 3
Figure 3
(a) LOQTEQ VA Periprosthetic Plate (with kind permission of aap Implantate AG, Berlin, Germany). (b) Insertable hinge with each of the two variable angle screw options (with kind permission of aap Implantate AG, Berlin, Germany). (c) Periprosthetic fracture around a cemented stable total hip revision arthroplasty. (d) LOQTEQ VA Periprosthetic Plate with mounted aiming device. (e) LOQTEQ VA Periprosthetic Plate with four inserted hinges. (f) Variable angle screw placement around the hip revision stem. (g) Postoperative X-rays. Four hinges with each of the two variable angle screw options were used to fix the plate around the hip stem.
Figure 3
Figure 3
(a) LOQTEQ VA Periprosthetic Plate (with kind permission of aap Implantate AG, Berlin, Germany). (b) Insertable hinge with each of the two variable angle screw options (with kind permission of aap Implantate AG, Berlin, Germany). (c) Periprosthetic fracture around a cemented stable total hip revision arthroplasty. (d) LOQTEQ VA Periprosthetic Plate with mounted aiming device. (e) LOQTEQ VA Periprosthetic Plate with four inserted hinges. (f) Variable angle screw placement around the hip revision stem. (g) Postoperative X-rays. Four hinges with each of the two variable angle screw options were used to fix the plate around the hip stem.
Figure 3
Figure 3
(a) LOQTEQ VA Periprosthetic Plate (with kind permission of aap Implantate AG, Berlin, Germany). (b) Insertable hinge with each of the two variable angle screw options (with kind permission of aap Implantate AG, Berlin, Germany). (c) Periprosthetic fracture around a cemented stable total hip revision arthroplasty. (d) LOQTEQ VA Periprosthetic Plate with mounted aiming device. (e) LOQTEQ VA Periprosthetic Plate with four inserted hinges. (f) Variable angle screw placement around the hip revision stem. (g) Postoperative X-rays. Four hinges with each of the two variable angle screw options were used to fix the plate around the hip stem.
Figure 4
Figure 4
(a) Interprosthetic hypertrophic non-union. Intraoperative situs showing the failed plate fixation and the non-union. (b) Intraoperative situs showing the double plating. (c) Double plating combined with bone-grafting and growth factor application. (d) Postoperative follow-up X-rays after 6 weeks, 12, and 24 months, demonstrating complete healing and remodeling of the fracture.
Figure 4
Figure 4
(a) Interprosthetic hypertrophic non-union. Intraoperative situs showing the failed plate fixation and the non-union. (b) Intraoperative situs showing the double plating. (c) Double plating combined with bone-grafting and growth factor application. (d) Postoperative follow-up X-rays after 6 weeks, 12, and 24 months, demonstrating complete healing and remodeling of the fracture.
Figure 5
Figure 5
Custom-made interposition sleeve (Waldemar Link GmbH, Hamburg, Germany).
Figure 6
Figure 6
Interprosthetic fracture around a stable total knee revision arthroplasty and a loose total hip revision arthroplasty. Implantation of a custom-made docking sleeve coupled to a proximal femur replacement (AQ-Implants GmbH, Ahrensburg, Germany).
Figure 6
Figure 6
Interprosthetic fracture around a stable total knee revision arthroplasty and a loose total hip revision arthroplasty. Implantation of a custom-made docking sleeve coupled to a proximal femur replacement (AQ-Implants GmbH, Ahrensburg, Germany).
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