Aggressive Surgical Treatment of Periprosthetic Femur Fractures Can Reduce Mortality: Comparison of Open Reduction and Internal Fixation versus a Modular Prosthesis Nail

Abstract

OBJECTIVES: The purpose of this study was to determine if immediate full weightbearing after surgical treatment for periprosthetic femur fractures can decrease perioperative and total mortality. DESIGN: Retrospective review. SETTING: Level II trauma center. PATIENTS: Fifty-two consecutive patients with a periprosthetic femur fracture during a 16-year time period. INTERVENTION: Comparison of open reduction and internal fixation with a plate (non- or partial postoperative weightbearing) versus stem exchange to a modular prosthesis nail (immediate full postoperative weightbearing). MAIN OUTCOME MEASUREMENTS: Six-month and total mortality using a Kaplan-Meier survival analysis. An additional matched subanalysis was performed for Vancouver Type B1 fractures. RESULTS: Patients permitted immediate postoperative full weightbearing had a significantly decreased total (P < 0.001) and 6-month mortality (P = 0.007). Subanalysis of patients with Vancouver Type B1 fractures also showed decrease in mortality, which was significant for total (P < 0.005) but not for 6-month mortality (P = 0.121). CONCLUSION: Treatment of periprosthetic femur fractures with femoral component exchange to a modular prosthetic nail that allows immediate postoperative full weightbearing may decrease mortality.