RESULTS OF AN OPERATIVE POLICY IN THE TREATMENT OF PERIPROSTHETIC FEMORAL FRACTURE

Objective: To determine the clinical outcome of patients with peripros thetic femoral fractures treated operatively. Design: Retrospective an alysis from 1986 to 1993. Setting: Edinburgh Orthopaedic Trauma Unit, Edinburgh, Scotland. Patients: Forty-five patients identified from a c omputer database as being admitted to the Edinburgh Orthopaedic Trauma Unit with periprosthetic femoral fractures. Main Outcome Measures: Cl inical outcome grade (good, fair, poor) dependent on integrity of fixa tion, refracture rate, and ability to perform activities of daily livi ng analyzed against age, type of fracture, prosthetic alignment, loose ning, and method of fixation. Results: Type I fractures were more comm on in uncemented or loosely cemented prostheses, whereas type II fract ures occurred predominantly in securely cemented prostheses. Type I fr actures treated by revision had the poorest results. Outcome in type I I fractures was equally good whether treated by internal fixation or b y revision. Age, loosening, and prosthetic alignment did not influence outcome. The mortality rate in this series was 20%. Conclusions: If a prosthesis is loose, it should be revised, or treatment varies with f racture and prosthetic type. In type I fractures, an uncemented stem m ay be revised to a cemented one; however, a securely cemented prosthes is probably is better when fixed internally. Type II fractures should be fixed internally because there is less operative insult. Type III f ractures probably are not related to the prosthesis and should be fixe d internally according to normal practice. The results of an operative policy compare well with the results of conservative management and a void the problems of long-term immobilization.