Validation of a new classification system for interprosthetic femoral fractures

Current methods and treatment options for interprosthetic femur fracture: an overview

“…This classification system correctly emphasized the particular difficulties in treating fractures around a revised TKR 13 . In a following study, the system showed a good interobserver agreement and an appropriate structure, but lacked statistical significance 14 .…”

“…Three subtypes based on the site of fracture and vicinity to the prosthesis were added to the Vancouver classification for IFFs 11 . Other authors added a subgroup D to Vancouver classification system: the authors highlighted the difficulty and the high failure rate to treat this pattern of fracture, while the importance to create this group is to provide a useful reminder for surgeons to place particular attention when choosing the surgical approach and technique due to the increased rate of failure [12][13][14][15] . Baba added the importance of such fracture in cemented or non-cemented stems to previous classification systems 16 .…”

“…However, we recognize that Pires classification system can be a valuable and reproducible model to classify and treat this type of injury 13 . Compared to the other systems, Pires classification provides a well-structured and understandable algorithm for surgeons, with high interobserver reproducibility 14 . Concerning biomechanical aspects, close attention must be paid to avoid stress risers.…”

<p>Interprosthetic femoral fractures: management challenges</p>

“…Depending on the quality of bone and usability of the original arthroplasty prostheses, consideration of a total femoral replacement or augmentation of the femur with a strut allograft is available tools in the armamentarium of this treatment algorithm (Type ID, IID, or III B-D). 25,26…”

“…Development of a preoperative surgical plan complete with any necessary implants, trays, and adjunct grafts is paramount to success in the operating room. When positioning patients for surgery, our preferred method is in the semi-lateral position on a beanbag over a fully radiolucent Figure 1 Interprosthetic femur fracture classification as described by Pires et al Note: Data from Pires et al 25,26 during various portions of the procedure the bag may be inflated or deflated to accommodate radiographic views or surgical visualization. Surgical approach may incorporate prior incisions but typically follows an extensile lateral exposure to the femur to facilitate exposure, fracture reduction, and fixation.…”