Periprosthetic fractures of the femur.

Treatment of periprosthetic femur fracture is based on fracture timing, implant stability, fracture pattern, and bone quality. Intraoperative fractures are usually stable; to prevent intraoperative fracture, careful preoperative planning and gentle operative techniques are essential. In managing unstable intraoperative and late postoperative periprosthetic fractures, the surgeon should be know the exact pattern of fracture, prosthesis stability, and bone quality. Loose prostheses should be revised and displaced fractures should be reduced and adequately fixed. These fractures typically occur in the peritrochanteric area, and their treatment is cerclage wiring or cables. Postoperative periprosthetic fractures are usually the result of trauma in the setting of loosening of the prosthesis and/or osteolysis. Periprosthetic femoral fractures are classified using the Vancouver classification, which is based on the location of the fracture, the amount of available proximal bone stock, and the stability of the stem. Correct classification of these fractures is important, as it helps to guide treatment.