Major joint arthroplasty procedures are among the most common and effective orthopaedic surgeries performed worldwide.1,2 With increasingly aging and more active populations and the expansion of surgical indications to include younger patients, the incidence of these procedures continues to increase.3–5 Consequently, intraoperative and postoperative complications related to the procedures, including periprosthetic fractures (PPFs), also are on the rise.6–8 Although reported incidences vary widely, even among the same types of fractures, and likely underrepresent the true numbers of fractures, PPFs represent a significant socioeconomic burden.8,9
The goal of management is to ensure adequate stability and restore mobility early while minimizing potential treatment complications. The general medical frailty of patients sustaining PPFs complicates the management of these conditions, and many of those affected are highly susceptible to the consequences of impaired mobilization postinjury. Outcomes depend on patient-related (eg, age, physiological condition, medical comorbidities, quality of bone, presence of osteolysis, previous procedures, sex) and surgeon-related (eg, diagnosis, choice of procedure, selected implant, and surgical technique) factors.7–12 Classification systems, which differ for different anatomical regions, both categorize fracture types and can guide management.7–12 In addition, prevention strategies should be used to diminish the PPF risk whenever possible, including medical management and nonsurgical modalities, such as fall prevention and physical therapy.7
Globally, orthopaedic surgeons increasingly find themselves managing patients with PPFs, which frequently present challenging problems in medically complex patients. Many orthopaedists, including traumatologists, now refer to or manage these patients in collaboration with specialists experienced in treating PPFs or who are able to manage revision arthroplasty surgery. Understanding successful approaches to the various types of PPFs will enable the global orthopaedic community to develop and employ best practices to treat these demanding injuries. The articles in this supplement address the treatment of the most commonly encountered PPFs, specifically those in the proximal humerus, acetabulum, proximal femur, distal femur, and proximal tibia. This work represents a collaborative effort of the member societies of the International Orthopaedic Trauma Association, an international association of orthopaedic organizations dedicated to the promotion of musculoskeletal trauma care through advancements in patient care, research, and education (www.internationalota.org). The hope is that the information provided in this supplement will improve the care of patients with PPFs.
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