Highlights
- •This is the first time that data for a systematic classification for peri-implant femoral fractures using a global and common language have been tested.
- •The proposal for classification is simple and easy to memorize and reproduce.
- •Fractures through a correctly implanted nail or plate are not uncommon.
- •The most common peri-implant femoral fractures were located at the diaphyseal segment and associated with nails or plates.
- •The proposed classification for peri-implant femoral fractures appears to be useful and user-friendly.
Abstract
Background Peri-implant fractures occur in association with an implant used to treat
a previous injury and that is still attached to the bone. Peri-implant fractures are
considered to be relatively “new” fractures and they lack any classification system
that is accepted in practice. Generally, the fracture classification systems currently
used in our clinical practice were not developed or validated using rigorous scientific
evaluation methods.
Aim To provide data for a proposed classification of peri-implant femoral fractures.
Methods This is an international and multicentre study (12 centres) based on a cohort
of consecutive peri-implant fractures with the criterion being: a fracture in any
segment of the femur in association with previously-used osteosynthesis material,
whether a nail, plate or screws. A proposed system for the classification was tested,
based on a topographical classification using alphanumeric coding, following a similar
nomenclature to that explained in the “Vancouver-Classification-for-Total-Hip-Arthroplasty-Periprosthetic-Fractures”,
and classified according to whether the implant is a nail, a screw or a plate, and
the location of the fracture in relation to the original implant and the affected
femoral segment.
The study coordinator performed the first classification exercise, which was discussed
subsequently for the study coordinator group to reach a consensus. A descriptive analysis
of the fractures was produced. The proportion of peri-implant femoral fractures was
estimated, and 95% confidence interval (95%CI) was calculated.
Results Between January 2013 and December 2016, data on a total of 143 peri-implant
femoral fractures were collected.
Only 5 (3.5%) fractures had to be discussed to reach a consensus. The most common
peri-implant femoral fractures were located at the diaphyseal segment (#32) and associated
with nails or plates: 51%, 73/143, 95%CI:43-59%; at the proximal segment (#31): 39%,
56/143, 95%CI:32-47%; and at the distal femoral segment (#33): 10%, 14/143, 95%CI:6-16%.
The highest proportion of peri-implant femoral fractures corresponded to #31-AN (trochanteric
and neck area) and #32-CNP (diaphysis fractures distant from the implant, often distal
and spiral).
Conclusion The proposed classification for peri-implant femoral fractures appears
to be useful and easy to accomplish. Future studies will be necessary to validate
it and demonstrate the effectiveness of its application in clinical practice.
Keywords
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Article info
Publication history
Published online: October 31, 2018
Accepted:
October 28,
2018
Identification
Copyright
© 2018 Published by Elsevier Ltd.
