[Treatment concepts of femoral fractures after total endoprosthetic replacement of the hip or knee joint: intra- or extramedullary stabilization?].

A comparison between intramedullary (n = 13) and extramedullary (n = 37) stabilization was performed in 50 patients (mean age 67.4 years) after fractures of the femoral shaft following knee or hip arthroplasty. Fracture of the femoral shaft (mean 5.5 years after the implantation) is observed especially often in patients with osteoporosis, loosening of the prosthesis, and rheumatoid arthritis. The ratio between cemented and uncemented endoprosthesis was 4:1. The investigation shows that extramedullary stabilization by means of plates and screws is the preferred treatment for younger patients and in the case of distal fractures, while in older people intramedullary fixation in combination with an additional osteosynthesis allows early mobilization. The number of complications observed is higher than with primary arthroplasty. The frequency of further operations, postoperative fractures and unsatisfactory results is significantly higher than in primary hip and knee surgery or uncomplicated fracture of the femur.