Peri-implant femoral fractures in elderly: Morbidity, mortality, treatment options and good practices.
10.1016/j.cjtee.2024.07.012
- Author:
Luca Bianco PREVOT
1
;
Vittorio BOLCATO
2
;
Stefania FOZZATO
3
;
Riccardo ACCETTA
3
;
Michela BASILE
4
;
Livio Pietro TRONCONI
5
;
Giuseppe BASILE
3
Author Information
1. Traumatology Unit, IRCCS Orthopedic Institute Galeazzi, Milan, 20157, Italy; Residency Program in Orthopedics and Traumatology, University of Milan, Milan, 20122, Italy.
2. Astolfi Association Legal Firm, Milan Unit, Milan, 20122, Italy. Electronic address: bolcatovittorio@yahoo.it.
3. Traumatology Unit, IRCCS Orthopedic Institute Galeazzi, Milan, 20157, Italy.
4. Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, 98122, Italy.
5. Maria Cecilia Hospital, Cotignola, Ravenna, 48033, Italy.
- Publication Type:Journal Article
- Keywords:
Complication;
Hip fracture;
Informed consent;
Internal fixation;
Mortality and morbidity;
Peri-implant femoral fracture;
Stress riser
- MeSH:
Humans;
Female;
Male;
Aged;
Femoral Fractures/mortality*;
Retrospective Studies;
Aged, 80 and over;
Periprosthetic Fractures/epidemiology*;
Fracture Fixation, Intramedullary/adverse effects*;
Postoperative Complications/mortality*
- From:
Chinese Journal of Traumatology
2025;28(6):497-502
- CountryChina
- Language:English
-
Abstract:
PURPOSE:Femur fractures are among the most common fractures treated surgically, representing a significant challenge for the orthopedic surgeon. Peri-implant femoral fractures (PIFFs) represent a rare complication of the surgical treatment. It is necessary to pay attention during osteosynthesis, evaluating not only the fracture site but the entire femoral skeletal structure, the characteristics of the fracture, the health comorbidities, and the risk of malunion and pseudarthrosis. There are few studies on the incidence, treatment, and outcomes of PIFFs near osteosynthesis. This study aimed to investigate PIFF after osteosynthesis of femoral fractures and evaluate the mortality after surgery and the morbidity associated with these types of fractures.
METHODS:A retrospective cohort study was carried out at the IRCCS Galeazzi Orthopedic Institute, Milan, Italy, between January, 2017 and December, 2022. Inclusion criteria were the presence of a femur fracture around an intramedullary nail to treat a previous fracture, follow-up ≥ 12 months, and patients aged ≥ 65 years. Exclusion criterion was intraoperative periprosthetic fractures. The data were expressed as frequency and percentage. Continuous variables were expressed as mean ± standard deviation or median and range.
RESULTS:Overall, 25 patients were enrolled (88.0% female) and the mean age was 84.5 years (range of 70 - 92 years). There were 20 patients having type B PIFF and 5 having type C. In 22 patients, multiple comorbidities were found with an average Charlson comorbidity score of 5.5 and the mean time to peri-implant fracture was 38 months. After surgery, 1 patient (4.0%) presented renal failure, 1 (4.0%) needed removal surgery for their loosening, and 2 (8.0%) presented surgical site infection. Nine patients (36.0%) died within 1 year with a mortality rate of 20.0% at 30 days, 8.0% at 3 months, and 8.0% at 12 months.
CONCLUSIONS:PIFFs in elderly patients are associated with high short-term mortality and morbidity, so careful planning for primary fracture surgery and patient awareness to ensure prolonged compliance and a healthy lifestyle are essential for prevention.
