An artificial hip joint improves the quality of life of millions of people worldwide. However, despite all the progress in endoprosthetics, complications can occur, including so -called periprothetic fractures. These fractures in the immediate vicinity of the prosthesis can arise for different reasons and represent a major challenge for doctors and patients. Especially in the case of short -term prostheses, specific biomechanical factors must be observed that influence the risk of fracture. In this article, we consider the causes, diagnosis, treatment options and prevention of periprothetical fractures for short -sided prostheses.

What are periprothetic fractures?

Periphetic fractures are broken bones that occur in the area of ​​an already implanted artificial joint. These fractures typically occur in the vicinity of the prosthesis assistant and can arise both intraoperatively and postoperatively.

Classification of periprothetic fractures

Periphetic fractures are classified according to different systems. The frequently used Vancouver classification system divides fractures into:

• Type A : Fractures of the trochanter Major or Minor (mostly conservatively treatable)
• Type B1 : Fractures in the area of ​​prosthesis with a stable prosthesis
• Type B2 : Fractures with loosening of the prosthesis
• Type B3 : Fractures with poor bone quality
• Type C : fractures below the prosthesis community

The distinction between these types of fractives is crucial for the choice of the treatment method.

Why do fractures occur on short -sized prostheses?

Brief prostheses are designed in such a way that they enable bone -saving implantation. The fixation is primarily in the proximal thigh bone, which distributes the stress and force of strength differently than with conventional long -term prostheses.

Factors that increase the risk of fracture:

• False burden after the operation : A wrong burden in the first weeks after the implantation can increase the risk of microfractures.
• Insufficient primary anchoring : a poor fit or not optimal positioning of the implant can affect bone stability.
• The patient's age and bone density : Patients with osteoporosis have a higher risk of periprothetical fractures.
• Falls and trauma : direct bumps or falls can cause a fracture in the area of ​​the prosthesis.

Risk factors for periprothetic fractures in short -time prostheses

Patient -related factors:

• Osteoporosis or other diseases with reduced bone density
• Old age
• Missing muscles and lack of balance
• Inadequate postoperative rehabilitation

Implant -related factors:

• Inadequate bony integration of the prosthesis
• Choice of a prosthesis that is too small or too big
• Use of a design that is not optimally suitable for the patient

Surgical factors:

• Careless intraoperative manipulation of the bone
• Inadequate fixation of the prosthesis
• Use of unsuitable access (minimal versus conventional incisions)

Differences in periprothetic fractures between short shafts and straight shafts

1. Different anchoring in the bone

• Brief prosthesis is anchored metaphysaries, i.e. in the upper area of ​​the thigh bone. As a result, the diaphysis (the long tube content of the thigh bone) remains largely intact.
• Lightly dentures , on the other hand, extend deeper into the diaphysis and are firmly anchored there.

This different anchorage influences the type of fractures:

• In the case of short -term prostheses, fractures appear more in the proximal (upper) thigh area , especially if the metaphyseal anchor is not optimal.
• In the case of geradiness prostheses, fractures often occur in diaphysis , i.e. further down on the thigh bone. These fractures are more difficult to treat because they are often associated with a new, deep anchoring of the implant.

2. Stability and bone reserves

• One advantage of the short sector is that the shorter anchoring in the bone is preserved more bone substance. This can be helpful for a fracture, since more bone material is available for operational stabilization.
• In the case of geradiness prostheses, a periprothetical fracture can be more critical, since the bone structure has been changed more by the long anchorage and often fewer bone reserves are available.

3. Risk in the event of falls and accidents

• Radge prostheses increase the risk of distal fractures (deeper thigh fractures), since the rigid, long anchoring lever forces transfers to the lower part of the thigh bone.
• Brief prostheses usually have a lower risk of such distal fractures , since they are shorter and the power is limited to a smaller bone region.

4. Treatment options for fractures

• In the case of fractures around a short sector, it is often possible to provide them with plate osteosyntheses or other stabilizing measures without having to exchange the prosthesis.
• In the case of fractures around a straight -wing prosthesis, a change to a long -range, axle -guided or modular revision prosthesis is more often necessary.

5. Do short -sided prostheses have an advantage?

• Brief prostheses show a lower risk of serious diaphysar fractures because the bone structure is largely preserved.
• When fractures occur, they usually appear proximal bone , which offers better treatment options.
• In contrast, geriac prostheses have a higher risk of fractures in the middle and lower thigh area that are more difficult to supply.

All in all, short -sized prostheses offer certain advantages with regard to periprothetical fractures, especially with regard to bone maintenance and treatment options in the event of fracture.



Diagnosis of a periprothetic fracture

A quick and precise diagnosis is essential to initiate adequate treatment. Typical symptoms are sudden pain, swelling and restricted movement of the affected leg.

Diagnostic procedures:

1. X -rays to localize the fracture
2. Computer tomography (CT) for better representation of fractures and implant position
3. Magnetic resonance imaging (MRI) when suspected of soft tissue injuries

Treatment options for periprothetical fractures

The therapy depends on the type of fracture, the stability of the prosthesis and the patient's bone quality.

Conservative therapy

• Only applicable for stable fractures without prosthesis loosening
• Implementation through partial load and physiotherapy

Surgical therapy

1. Osteosynthesis : screwing or plate osteosynthesis in stable prostheses
2. Revision prosthesis : If the prosthesis is relaxed or massive bone damage is available
3. Bone transplantation or augmentation process : with strong osteoporosis or bone loss

Prevention of fractures for short -sided prostheses

Since periprothetic fractures represent serious complications, preventive measures are essential.

Choice of the right implant

• Individual adaptation to the patient's bone anatomy
• Use of modern implants with optimized anchorage

Optimization of the bone density

• Osteoporosis medictions and vitamin D supplementation
• Strength training to strengthen the muscles

Lateral behavior after the operation

• Avoiding falls through equilibrium training
• Consultation of the recommended postoperative stress limits

Conclusion and recommendation

Periphetic fractures are a serious complication in the endoprosthetics. Especially in the case of short -term prostheses, the individual adaptation to the patient is crucial in order to minimize the risk. Modern implants and improved surgical techniques have reduced the occurrence of such fractures, but precise diagnosis and treatment remains essential.

Patients who need a hip prosthesis or already have an implant should contact specialized centers in order to achieve the best possible results. The combination of precise surgical technology, high -quality implant choice and adapted rehabilitation minimizes the risk of complications and improves the long -term results for the patient.