Peri-implant Fractures

In the last 50 years, life expectancy has increased, entailing a biological impact that confers fragility to the last stage of life, with fragility fractures being another episode of organic deterioration. Increased physical activity leads to an increase in falls and thus increased incidence of periprosthetic and peri-implant fractures of the femur (PIFF). The PIFF are those that occur in relation to an implant (nail, plate, or screw) used to treat a previous injury and that still remains in the bone. Although there is variability regarding the time of appearance, PIFFs usually appear in the postoperative period, around 10 weeks after surgery or longer. The etiology is multifactorial, related to the patient himself/herself, to the surgical technique, and/or to the implant itself. Classification systems should facilitate communication between surgeons, to help documentation and research, as well as be a tool for planning and agreeing on treatment. Despite recent advances, there is still no consensus regarding the classification of PIFFs. The concept of splinting and protection of almost the entire femur should be the goal, avoiding to leave unprotected and fragile areas between implants. The treating surgeon should rule out whether the cause has been an infection and also determine whether or not the previous fracture is healed, because these will be the key points of the therapeutic strategy that will have as its final objective the early mobilization and functional recovering of the patient.