Biomechanical Evaluation of Peri- and Interprosthetic Fractures of the Femur

Background: Because of an increasing life expectancy of patients and the rising number of joint replacements, peri- and interprosthetic femoral fractures are a common occurrence in most trauma centers. This study was designed to answer two primary questions. First, whether the fracture risk increases with two intramedullary implants in one femur; and second, whether a compression plate osteosynthesis is sufficient for stabilizing an interprosthetic fracture. Methods: Twenty-four human cadaveric femurs were harvested and four groups were matched based on the basis of bone density using a peripher quantitative computer tomography (pQCT). All groups-(I) hip prosthesis with a cemented femoral stem; (II) hip prosthesis and retrograde femoral nail; (III) hip prosthesis, retrograde femoral nail, and lateral compression plate; (IV) all three implants with an additional simulated interprosthetic fracture-were biomechanically tested in a four-point bending in lateral-medial direction. Results: The second group with two intramedullary implants exhibited 20% lower fracture strength in comparison with group 1 with proximal femoral stem only. The stabilization of an interprosthetic fracture with a lateral compression plate (group IV) resulted in a fracture strength similar to femur with prosthesis only. Conclusion: Two intramedullary implants reduce the fracture strength significantly. If an interprosthetic fracture occurs, sufficient stability can be achieved by a lateral compression plate. Because two intramedullary implants in the femur may decrease the fracture strength, the treatment of supracondylar femoral fractures with a retrograde nail in cases with preexisting ipsilateral hip prosthesis should be reconsidered.