[Treatment of periprosthetic fractures : new concepts in operative treatment].

BACKGROUND: Periprosthetic fractures represent a common and complex challenge in the clinical practice in orthopedics and trauma surgery. Due to demographic changes characterized by increased life expectancy and higher numbers of primary arthroplasties, the number of periprosthetic fractures is increasing as well. Factors such as osteoporosis, multimorbidity and a highly active aging population additionally increase the complexity of periprosthetic fractures. INJURY PATTERNS: Most periprosthetic fractures affect the proximal and distal femur; however, periprosthetic fractures of the tibial head, the ankle, shoulders and the upper extremities as well as complex interprosthetic fractures pose an increasing challenge for orthopedic and trauma surgeons. THERAPY: Many therapeutic options exist and the number of implants especially designed to treat periprosthetic fractures is steadily rising. Principally, loosened prostheses are indicative for replacement operations whereas for periprosthetic fractures of well-anchored prostheses as a rule osteosynthesis is necessary. A standardized treatment algorithm does not yet exist and usually the decision of how to treat these fractures has to be made on an individual basis. PERSPECTIVES: The present article demonstrates the current state of open reduction and internal fixation of periprosthetic fractures with respect to biomechanical principles and furthermore provides an overview on implant augmentation.