Management of periprosthetic femoral fractures

We followed up 37 periprosthetic fractures to assess the factors related to the outcomes and the loosening of prostheses. The average union time is 3.1 months (range, 2–6.2 months). The most common types were fractures around the stem tip and displaced (89.1%). In our study, the loosening rate (32.4%) was low compared with other reports. These might be due to the cementless stem, but the difference was not significant (P>.05). After management of the fracture with a plate, we noted 5 complications: 2 nonunion and 3 refractures. The causes of these complications were related to screw in the level of the stem tip. Therefore, in the management of fractures with plates, we do not recommend using a screw in the area of the stem tip but rather using a cerclage proximally and bone graft. If stem was unstable or stability was uncertain, and the arthroplasty did not function well previously, revision with a distal fluted stem showed an early bony union.