Treatment of Interprosthetic Femoral Fracture Nonunion: A Systematic Review.

Treatment of Interprosthetic Femoral Fracture Nonunion: A Systematic Review.

Interprosthetic fractures (IFs) of the femur present complex injuries associated with increased morbidity and mortality. Limited bone stock between the proximal and distal prostheses makes fracture reduction and stabilization challenging. Nonunion is a common and severe complication of IFs, often requiring multiple interventions. This systematic review aimed to identify the most successful treatment for femoral IFs and determine the overall incidence and best management strategies for IF nonunion./r/nThere were five electronic databases (Medline/PubMed, Scopus, Web of Science, Cochrane, and EMBASE) searched for relevant studies published until July 2024. There were 35 studies that fulfilled the inclusion criteria./r/nA total of 503 patients who had 506 IFs were analyzed. The mean age was 79 years (range, 30 to 98), and 83.6% were women. The 1-year mortality was 9.9% (range, 0 to 66.7). In terms of fixation options, increased frequency of nonunion was found after nonoperative treatment (50%) and retrograde intramedullary nailing (RIN) (11.1%), while after the combination of open reduction and internal fixation (ORIF) with RIN, nonunion was not observed. In the subgroup analysis of patients treated with ORIF, dynamic condylar screws (33.3%) and conventional plates (27.3%) were related to increased frequency of nonunion compared to locking compression plates (9.1%), while double plating was the most successful method (nonunion was not reported). The overall nonunion rate was 9.5%. Depending on treatment modality, the incidence of nonunion was 8.7% after ORIF, 5.5% after revision arthroplasty combined with ORIF and 11.1% after RIN. For the treatment of nonunion, no secondary nonunion was reported after ORIF + RIN and double plating./r/nFor the treatment of IFs, nonlocking plating and RIN were associated with higher nonunion rates, whereas double plating and ORIF + RIN were the most successful treatment options. Interprosthetic fracture nonunion was reported in 9.5% of cases, but further research is warranted to determine the most successful management approach.