Concepts and Potential Future Developments for Treatment of Periprosthetic Proximal Femoral Fractures

Stephan Brand*, 1, Max Ettinger 2, Mohamed Omar 1, Nael Hawi 1, Christian Krettek 1, Maximilian Petri 1, 3
1 Trauma Department, Hannover Medical School, Germany
2 Orthopaedic Department, Hannover Medical School, Germany
3 Steadman Philippon Research Institute, Vail, CO, USA

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© Brand et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; Tel: +49 511-532-2050; Fax: +49 511-532-5877; E-mail:


Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies.

Keywords: Intraprosthetic screw fixation, periprosthetic fracture, Vancouver classification.