Official Journal of the Italian Society of Orthopaedics and Traumatology
Table 3 Management of all periprosthetic fractures (PPF), humeral shoulder PPF, humeral elbow PPF, pelvic hip PPF, femoral hip PPF, femoral knee PPF, tibial knee PPF, and tibial ankle PPF (humeral elbow PPF and patellar PPF are not detailed; n = 4 and n = 5, respectively)
PPF | Humeral shoulder PPF | Pelvic hip PPF | Femoral hip PPF | Femoral knee PPF | Tibial knee PPF | Tibial ankle PPF | |
|---|---|---|---|---|---|---|---|
N = 1387 | N = 32 | N = 31 | N = 720 | N = 544 | N = 41 | N = 10 | |
Treatment—no. (%) | |||||||
Operative | 1137 (82) | 29 (90.6) | 17 (54.8) | 555 (77.1) | 494 (90.8) | 26 (63.4) | 9 (90) |
Non-operative | 248 (17.9) | 3 (9.4) | 14 (45.2) | 165 (22.9) | 49 (9) | 14 (34.1) | 1 (10) |
N/A | 2 (0.1) | 1 (0.2) | 1 (2.4) | ||||
Surgical delay (h) | |||||||
Median (IQR) | 92.5 (51.9–153.6) | 152.5 (82.6–208) | 141.1 (65.3–210) | 97.9 (56.4–157) | 86.3 (48–136.4) | 203.7 (96.4–288) | 71.2 (45.25–120) |
N/A | 8 (0.7) | 4 (12.5) | 14 (45.2) | 2 (0.3) | 3 (0.6) | 16 (39) | 1 (10) |
Type of anaesthesia | |||||||
General | 251 (22.1) | 26 (89.7) | 8 (47.1) | 139 (25) | 68 (13.8) | 6 (23.1) | 1 (10) |
Spinal | 784 (69) | 2 (6.9) | 10 (58.8) | 371 (66.8) | 374 (75.7) | 17 (65.4) | 6 (60) |
Regional | 173 (15.2) | 6 (20.7) | 0 (0) | 77 (13.9) | 82 (16.6) | 4 (15.4) | 3 (30) |
Surgical approach | |||||||
Open | 745 (65.4) | 27 (93.1) | 15 (88.2) | 437 (78.7) | 238 (48.1) | 16 (59.3) | 6 (66.7) |
MIS | 233 (20.5) | 2 (6.9) | 1 (5.9) | 69 (12.4) | 155 (31.3) | 3 (11.1) | 2 (22.2) |
PC | 152 (13.3) | 0 (0) | 1 (5.9) | 44 (7.9) | 100 (20.2) | 6 (22.2) | 1 (11.1) |
N/A | 9 (0.8) | 0 (0) | 0 (0) | 5 (0.9) | 2 (0.4) | 1 (3.7) | 0 (0) |
Direct stability check | |||||||
No | 501 (44.1) | 9 (31) | 3 (17.6) | 191 (34.4) | 276 (55.9) | 13 (50) | 7 (77.8) |
Yes, from the joint | 266 (23.4) | 6 (20.7) | 13 (76.5) | 153 (27.6) | 85 (17.2) | 6 (23.1) | 0 (0) |
Yes, from the fracture site | 364 (32) | 14 (48.3) | 1 (5.9) | 206 (37.1) | 133 (26.9) | 6 (23.1) | 2 (22.2) |
N/A | 8 (0.7) | 0 (0) | 0 (0) | 5 (0.9) | 1 (0.2) | 1 (3.8) | 0 (0) |
Cerclage for reduction | |||||||
No | 611 (53.7) | 13 (44.8) | 12 (70.6) | 156 (28.1) | 397 (80.4) | 23 (88.5) | 8 (88.9) |
Yes | 520 (45.7) | 16 (55.2) | 5 (29.4) | 394 (71) | 97 (19.6) | 2 (7.7) | 1 (11.1) |
N/A | 8 (0.7) | 0 (0) | 0 (0) | 5 (0.9) | 1 (0.2) | 1 (3.8) | 0 (0) |
Replacement | |||||||
No | 887 (78) | 25 (86.2) | 5 (29.4) | 362 (65.2) | 462 (93.5) | 19 (73.1) | 8 (88.9) |
Yes (cementless) | 156 (13.7) | 0 (0) | 9 (52.9) | 139 (25) | 5 (1) | 2 (7.7) | 0 (0) |
Yes (cemented) | 88 (7.7) | 4 (13.8) | 3 (17.6) | 49 (8.8) | 27 (5.5) | 4 (15.4) | 1 (11.1) |
N/A | 8 (0.7) | 0 (0) | 0 (0) | 5 (0.9) | 1 (0.2) | 1 (3.8) | 0 (0) |
Type of fixation | |||||||
1 plate | 638 (56.1) | 19 (65.5) | 4 (23.5) | 327 (58.9) | 270 (54.7) | 13 (50) | 4 (44.4) |
2 plates | 46 (4) | 4 (13.8) | 1 (5.9) | 6 (1.1) | 27 (5.5) | 4 (15.4) | 3 (33.3) |
Nail | 194 (17.1) | 1 (3.4) | 0 (0) | 58 (10.5) | 135 (27.3) | 0 (0) | 0 (0) |
Ex fix | 4 (0.4) | 0 (0) | 0 (0) | 0 (0) | 3 (0.6) | 1 (3.8) | 0 (0) |
Cerclage | 300 (26.4) | 7 (24.1) | 1 (5.9) | 240 (43.2) | 46 (9.3) | 2 (7.7) | 0 (0) |
Isolated screws | 19 (1.7) | 0 (0) | 2 (11.8) | 2 (0.4) | 9 (1.8) | 3 (11.5) | 2 (22.2) |
Bone graft | |||||||
No | 1070(77.1) | 24 (25) | 14 (45.2) | 515 (71.5) | 479 (88.1) | 25 (61) | 8 (80) |
Yes: | 317 (22.9) | 8 (75) | 17 (54.8) | 205 (28.5) | 65 (11.9) | 16 (39) | 2 (20) |
Strut | 33 (2.9) | 4 (13.8) | 0 (0) | 23 (4.1) | 4 (0.8) | 0 (0) | 0 (0) |
N/A | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Overlap in mm | |||||||
Yes | 653 (57.4) | 20 (69) | 2 (11.8) | 322 (58) | 290 (58.7) | 12 (46.2) | 4 (44.4) |
Median (IQR) | 87 (4 –142) | 77 (53–93.5) | 135 (127.5–142.5) | 130 (90–161) | 50 (37–75.8) | 42 (20–73.25) | 61.5 (59–79.25) |
Gap in mm | |||||||
Yes | 118 (10.4) | 3 (10.3) | 0 (0) | 41 (7.4) | 64 (13) | 6 (23.1) | 4 (44.4) |
Median (IQR) | 140 (33–200) | 42 (22.5–57.5) | 140 (67–200) | 130.5 (23.8–189.8) | 135 (75–207) | 225 (186–262.5) | |
Kissing implants | |||||||
Yes | 31 (2.7) | 0 (0) | 0 (0) | 6 (1.1) | 25 (5.1) | 0 (0) | 0 (0) |
Surgeon experience | |||||||
> 20 replacements | 316 (27.8) | 7 (24.1) | 10 (58.8) | 206 (37.1) | 84 (17) | 5 (19.2) | 2 (22.2) |
> 20 MIPO | 324 (28.5) | 10 (34.5) | 6 (35.3) | 124 (22.3) | 172 (34.8) | 8 (30.8) | 3 (33.3) |
< 20 replacements & MIPO | 533 (46.9) | 14 (48.3) | 3 (17.6) | 247 (44.5) | 248 (50.2) | 12 (46.2) | 5 (55.6) |