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.
Humans ; Female ; Male ; Aged ; Femoral Fractures/mortality* ; Retrospective Studies ; Aged, 80 and over ; Periprosthetic Fractures/epidemiology* ; Fracture Fixation, Intramedullary/adverse effects* ; Postoperative Complications/mortality*

Periprosthetic acetabular fracture (PAF) is an uncommon complication following hip arthroplasty. However, as the number of people needing hip prostheses continues to rise, the absolute number of PAF is expected to increase as well. These fractures may occur either intraoperatively or postoperatively. Postoperative fractures can be caused by traumatic events or by pathologic conditions related to periacetabular osteolysis. The management of PAF usually depends on the degree of displacement and the stability of the acetabular component. While most of non-displaced fractures can be managed nonoperatively by protected weight bearing, displaced fractures with unstable implants require surgical intervention, which is often technically challenging. This review summarized the latest findings on the epidemiology, the diagnosis, the classification, and the treatment of PAF.
Acetabulum ; Arthroplasty ; Classification ; Diagnosis ; Epidemiology ; Hip Prosthesis ; Hip ; Osteolysis ; Periprosthetic Fractures ; Weight-Bearing

PURPOSE: Periprosthetic fracture (PPF) is a serious complication that occurs in 0.3%-2.5% of all total knee arthroplasties used to treat end-stage arthritis. To our knowledge, there are no studies in the literature that evaluate the association between time to surgery after PPF and early postoperative infections or deep vein thrombosis (DVT). This study tests our hypothesis that delayed time to surgery increases rates of postoperative infection and DVT after PPF surgery. METHODS: Our study cohort included patients undergoing PPF surgery in the American College of Surgeons National Surgical Quality Improvement Program database (2006-2015). The patients were dichotomized based on time to surgery: group 1 with time ≤2 days and group 2 with time >2 days. A 2-by-2 contingency table and Fisher's exact test were used to evaluate the association between complications and time to surgery groups, and multivariate logistic regression was used to adjust for demographics and known risk factors. RESULTS: A total of 263 patients (80% females) with a mean age of 73.9 ± 12.0 years were identified receiving PPF surgery, among which 216 patients were in group 1 and 47 patients in group 2. Complications in group 1 included 3 (1.4%) superficial infections (SI), 1 (0.5%) organ space infection (OSI), 1 (0.5%) wound dehiscence (WD), and 4 (1.9%) deep vein thrombosis (DVT); while complications in group 2 included 1 (2.1%) SI, 1 (2.1%) OSI, 1 (2.1%) DVT, and no WD. No significant difference was detected in postoperative complications between the two groups. However, patients in group 2 were more likely (p = 0.0013) to receive blood transfusions (57.5%) than those in group 1 (32.4%). CONCLUSION Our study indicates patients with delayed time to surgery have higher chance to receive blood transfusions, but no significant difference in postoperative complications (SI, OSI, WD, or DVT) between the two groups.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; adverse effects ; Blood Transfusion ; statistics & numerical data ; Cohort Studies ; Female ; Humans ; Infection ; epidemiology ; Logistic Models ; Male ; Middle Aged ; Periprosthetic Fractures ; etiology ; surgery ; Postoperative Complications ; epidemiology ; Risk Factors ; Surgical Wound Dehiscence ; epidemiology ; Surgical Wound Infection ; epidemiology ; Time Factors ; Venous Thrombosis ; epidemiology

OBJECTIVETo analyze the gender, age, fracture classification and variation trend of adult intertrochanteric fractures treated in a single-center hospital in ten years.

METHODSThe data of adult (age ≥ 16 years) intertrochanteric fractures admitted to the Third Hospital of Hebei Medical University from January 2003 to December 2012 were collected retrospectively. All the fractures were acute and the pathological or periprosthetic fractures were excluded. The radiography of fracture were classified by same experienced orthopedic resident and verified by two orthopedic deans and one radiologist. The gender, age and fracture classification were analyzed and compared between January 2003 to December 2007 and January 2008 to December 2012.

RESULTSA total of 3 201 cases were collected. The adult intertrochanteric fractures accounted for 2.97% of all adult fractures and 43.76% of adult proximal femoral fractures. Of all fractures 64.98% were elderly ( ≥ 60 years) and 35.02% were middle-aged (16-59 years). In elderly, female were common (57.78%) while in middle-aged were male commonly (79.13%). According to Evans classification, instable fractures were more common (68.92%). According to AO classification, the most common type was A2 (49.67%) and the least was A3 (15.93%). Comparing between January 2003 to December 2012 and January 2008 to December 2012, the proportion of intertrochanteric fracture of adult fracture was decreased by 0.31% (χ² = 9.29, P = 0.002)and the proportion of intertrochanteric fracture of adult proximal femoral fractures was decreased by 3.15% (χ² = 7.35, P = 0.007). The proportion of elderly patients, female and stable fractures was increased by 14.35% (χ² = 71.98, P < 0.01), 4.04% (χ² = 8.16, P = 0.004) and 5.62% (χ² = 11.7, P = 0.001), respectively. The proportion of AO classification was not significantly verified (χ² = 3.24, P = 0.198).

CONCLUSIONSThe intertrochanteric fractures are most common in elderly patients, A2-type of AO Classification and stable (Evans III, IV, V) in Evans classification. Compared with the previous five years, the proportions of female, elderly and stable (Evans I, II) fracture increase in last 5 years.

Adolescent ; Adult ; Aged ; China ; epidemiology ; Female ; Femoral Fractures ; diagnostic imaging ; epidemiology ; surgery ; Hip Fractures ; diagnostic imaging ; epidemiology ; surgery ; Humans ; Male ; Middle Aged ; Periprosthetic Fractures ; Radiography ; Retrospective Studies ; Young Adult

BACKGROUND: The osteosynthesis of the periprosthetic fractures following a total knee arthroplasty (TKA) can be technically difficult with the relatively small satisfactory outcomes and the high complication rates. The purpose of the study is to analyze the mid-term radiological and functional outcomes following the locked plating of the distal femur periprosthetic fractures after a TKA. METHODS: Records of 20 patients with a periprosthetic distal femur fracture following TKA treated by the locked plate osteosynthesis were retrospectively evaluated. The union rate, complications and functional outcome measures were analyzed. RESULTS: Successful union was achieved in 18 of the 19 patients available for the follow-up. The mean follow-up was 39 +/- 10 months. Significant reductions (p < 0.05) in the range of motion and Western Ontario and McMaster Universities Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were evident in the follow-up. Secondary procedures were required in 5 patients to address the delay in union and the reduced knee range of motion. The osteosynthesis failed in 1 patient who underwent a revision TKA. CONCLUSIONS: The satisfactory union rates can be achieved with the locked plate osteosynthesis in the periprosthetic distal femur fractures after TKA. Prolonged rehabilitation coupled with the un-modifiable risk factors can decrease the activity and satisfaction levels, which can significantly alter the functional outcome.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*adverse effects ; Female ; Femoral Fractures/*etiology/radiography ; Fracture Fixation, Internal/*adverse effects ; Humans ; Male ; Osteoporosis/epidemiology ; Periprosthetic Fractures/*etiology/radiography ; Postoperative Complications/etiology ; Range of Motion, Articular ; Retrospective Studies ; Risk Factors ; Treatment Outcome