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Review
. 2024 Jan 9;9(1):40-50.
doi: 10.1530/EOR-23-0105.

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators' recommendations

Pablo Castillón  1   2 , Josep Maria Muñoz Vives  3   4 , Héctor José Aguado  5   6 , Arantxa Capel Agundez  7 , Alina Ortega-Briones  5 , Jorge Hassan Núñez  1   2
Collaborators, Affiliations
Review

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators' recommendations

Pablo Castillón et al. EFORT Open Rev. .

Abstract

A peri-implant femoral fracture (PIFF) is defined as a femoral fracture in the presence of a pre-existing non-prosthetic implant. Classification systems, treatment guidelines and fixation strategies exist for peri-prosthetic fractures, but there is no standard of care regarding PIFFs. The aim of the Peri-Implant Spanish Consensus (aka PISCO) investigators is to reach an agreement regarding current practices for management of PIFFs and to propose four main principles to assess surgical treatment and prevention of these fractures. This consensus review was conducted according to the Delphi method. Twenty-two expert orthopaedic trauma surgeons performed the consensus and the definitive statements were approved unanimously. Biological fixation principles must be utilized in the surgical treatment of peri-implant femur fractures, which include closed or minimally invasive reduction techniques. The osteosynthesis must protect the entire bone. Gaps between two implants should be avoided. If implant overlap is not possible to achieve, then spanning inter-implant fixation systems must be used, especially in osteoporotic bone. Previous implants should be retained during surgical treatment of peri-implant femur fractures. Only those implants that would interfere with current fixation goals should be removed. If the previous implant is in the femoral neck region, then femoral neck protection must be maintained when treating the peri-implant fracture, even if the neck fracture has already healed.

Keywords: consensus; femur; hip fracture; peri-implant fractures.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this review.

Figures

Figure 1
Figure 1
Peri-implant femur fracture.
Figure 2
Figure 2
The four principles applied in the final fixation. Principle 1. Biological fixation and protection of the entire femur. Principle 2. Implant overlapping. Principle 3. Only diaphyseal screws removal. Principle 4. Femoral neck protection maintained.
Figure 3
Figure 3
The four principles for management of PIFFs.
See this image and copyright information in PMC

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