The management of proximal periprosthetic femoral fractures: Is open reduction and internal fixation a solution for all fractures treated surgically around a polished tapered stem?

Aims & objectives: The aim of this study is to assess whether open reduction and internal fixation (ORIF) is appropriate for the surgical management of all proximal femoral periprosthetic fractures involving a polished tapered stem. Methods: This retrospective case series assessed the five year follow-up of 105 consecutive patients treated with ORIF following proximal femoral periprosthetic fractures with minimum 12-month follow-up. Primary outcome measure of this study was union at one year following surgery and secondary outcome measures included reoperation, post-operative infection and dislocation. Results: 105 patients had periprosthetic fractures over 10 years (B1 n = 31; B2 n = 64; and C n = 10). Union within one year of periprosthetic fractures were achieved in 76.7 % of short oblique/transverse fractures and 100 % of long spiral fractures. The fracture pattern and fracture location with B1, B2 and C type were disturbed in a statistically significant pattern. Importantly, each periprosthetic fractures that did not achieve union by one year resulted in plate breakage which resulted in further major revision surgery. Conclusions: We advocate that ORIF should be attempted in all proximal femoral periprosthetic fractures as only a small number of patients develop non-union and go on to require further surgery. Short oblique fractures at the tip of the stem are higher risk for non-union and dual plating could be considered in these cases.