• Christian Wulbrand, Franz Müller, Bernd Füchtmeier, and Alexander Hanke.
• Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany. Christian.Wulbrand@barmherzige-regensburg.de.
• Eur J Trauma Emerg Surg. 2024 Aug 1; 50 (4): 167116791671-1679.

PurposeThe incidence of peri-implant femoral fractures (PIFF) is increasing. Information regarding outcomes, timing of surgery, risk factors, and a clinically applicable treatment algorithm are lacking. The aim of this study was to identify outcome-related risk factors and to derive a treatment algorithm.MethodsSixty-four PIFFs treated between 01.01.2006 and 31.12.2020 in a level I trauma centre were evaluated retrospectively for fracture pattern, surgical technique, risk factors, complications, and 1-year mortality. The study was approved by the ethics committee (No. 21-2714-104).ResultsOne-year mortality was 24.1%. Surgical complications occurred in 4.7%, and general complications in 15.6% of the patients. General complications, low haemoglobin level at admission, elevated CHA2DS2-VASc, and Charlson score resulted in increased 1-year mortality. Time to surgery > 24 h did not increase complication or mortality rates. The three predominant fracture patterns were fractures close or distal to cephalomedullary nails, close or proximal to distal lateral plates, and close or distal to sliding hip screws. Recommendations for surgical treatment were derived: Osteosynthesis should enable as much weight-bearing as possible; the initial implant should only be removed, if this is essential for the new osteosynthesis; lateral locking plates should span the whole femur; antegrade nails should have a cephalomedullary component to avoid consecutive femoral neck fractures; implants should overlap to reduce the risk of consecutive inter-implant fractures.ConclusionRisk factors for 1-year mortality in patients with PIFFs were identified. A treatment algorithm and general principles for surgery of PIFFs were developed.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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