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A Retrospective analysis of peri-implant fractures: insights from a large volume clinical Study

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Abstract

Purpose

Peri-implant fractures (PIFs) are a concept in evolution for which different diagnostic criteria have been proposed and modified over time. They have not been extensively reported. PIFs are usually located in the distal part of previous osteosynthesis, where fragile bone is in contact with the rigid implant and are a significant complication after orthopaedic surgery, which requires careful management and treatment. This clinical study presents findings from a retrospective analysis of PIF’s, providing description of characteristics and outcomes. They provide information about the associated risk factors and description of the effectiveness of various treatments.

Materials and methods

A retrospective analysis was performed in a clinical study involving patients with PIFs. Data from medical records, radiographic images, and surgical reports were collected and analyzed. The study included patients with refracture of pre-existing osteosynthesis admitted to the hospital between 2015 and 2022. Demographic information, fracture characteristics, surgical interventions, and post-operative outcomes were assessed. Each case was followed for a minimum of one year after surgery, and a critical analysis was performed by senior surgeons. Furthermore, the PIFs were classified according to the type of initial implant and the position of the new fracture in relation to the original implant.

Results

Between 2015 and 2022, out of 18,813 fractures treated at a Level 1 traumatology hospital, a total of 85 patients with PIF’s were identified. Fracture characteristics varied, including location, fracture pattern, and implant type. Most of the PIFs, 71 cases (83.53%), occurred in the femur. Additionally, there were seven cases (8.24%) involving the humerus, four cases (4.71%) affecting the tibia/fibula, two cases (2.35%) in the radius, and one case (1.18%) involving the clavicle. Surgical management was the primary attitude in treatment. Various techniques were used, including the use of longer and stronger implants to achieve high-quality fixation, facilitating early rehabilitation and return to previous activities. Postoperative complications after surgery for PIFs were observed in 16 cases (18.8%).

Conclusions

Peri-implant fractures (PIF) are a distinct topic and a challenging condition with a high rate of postoperative complications. Complications after the second surgery may be severe and life threatening in older patients. A classification can be useful to make decisions about the optimal treatment in different anatomic areas and type of implant used for primary osteosynthesis. Currently there are no standardized protocols for management, therefore each case should be carefully discussed and planned before surgery.

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The authors confirm that this manuscript was prepared without the benefit of any funds, grants, or additional forms of support.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania

    Manuela Poroh, Bogdan Puha, Norin Forna, Paul Sirbu & Ovidiu Alexa

  2. Sf. Spiridon’ County Emergency Hospital, Iasi, Romania

    Bogdan Puha, Teodor S. Gheorghevici & Ovidiu Alexa

  3. MedLife Orthopedics Hospital, Bucharest, Romania

    Constantin Jemna

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  1. Manuela Poroh
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Contributions

All authors played a role in conceiving and designing the study. The tasks of preparing materials, collecting data, and analyzing the results were undertaken by all. The initial draft of the manuscript was composed by MP, and every author provided comments on earlier drafts. The final manuscript was read and approved by all authors.

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Correspondence to Manuela Poroh.

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This study was performed in accordance with the approval of the Ethics Committee of 'Sf. Spiridon's County Emergency Hospital, Iasi, Romania. Furthermore, each individual participant involved in the study provided their informed consent to participate in the study and the publication of the images.

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Poroh, M., Puha, B., Gheorghevici, T.S. et al. A Retrospective analysis of peri-implant fractures: insights from a large volume clinical Study. International Orthopaedics (SICOT) 47, 2859–2868 (2023). https://doi.org/10.1007/s00264-023-05939-y

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