ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Peri-periprosthetic femoral fractures: a single-centre case series of a rare and challenging clinical scenario.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePeriprosthetic femoral fractures (PFFs) are an increasingly common complication of hip arthroplasty. A poorly defined scenario is a new femoral fracture after a previously treated PFF has united, which we term a peri-periprosthetic femoral fracture.
methodsWe retrospectively reviewed 154 surgically treated PFF episodes in patients aged over 65 years at our institution between 2011 and 2021. A peri-periprosthetic fracture was defined as a new acute femoral fracture after documented radiographic union of a previously treated PFF. Clinical, surgical, and radiographic data were reviewed.
resultsSeven patients (4.5% of the institutional PFF cohort) met the criteria. Mean age was 83.1 years and 6 (85.7%) were female. The mean interval to the peri-periprosthetic fracture was 37.3 months (median 27; range 7-105). By the Vancouver classification, 3 fractures were type B1, 1 type B3, and 3 type C. Treatment was individualised to fracture configuration, prosthetic stability, hardware, and bone stock. Radiographic union was documented in all 4 patients with adequate follow-up, at a mean of 4.3 months. Five patients regained ambulation; one with pre-existing limitations did not, and ambulatory status was unavailable for one. Medical complications occurred in 2 patients, and no major orthopaedic complication required reoperation. Mortality was 14.3% at one year and 42.9% at two years.
conclusionPeri-periprosthetic femoral fractures constitute a rare and technically demanding scenario, distinct from delayed union, nonunion, refracture through an incompletely healed fracture, and fixation failure. Treatment should be individualised to prosthetic stability, pre-existing hardware, fracture morphology, and residual bone stock.
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