Open Reduction and Internal Fixation of Extremely Proximal Periprosthetic Fractures of the Hip

Introduction Controversy surrounds the optimal treatment of very proximal fractures around femoral components. No published studies exist evaluating the outcomes of ORIF of fractures with a primary fracture line proximal to the distal tip of the femoral component. These patterns typically have a short “ring” of proximal bone including the greater and lesser trochanters that is well fixed to the porous surface of the stem, but the distal portion of the stem is detached from the femur. The purpose of this multi-center study is to learn more about the results and complications of ORIF in this setting. Patients and Methods Between 2008–2022, twenty-three patients with a mean age of 83 years (Range 59 – 98) were treated at two Level One Trauma Centers with ORIF of an extremely proximal PPFX. All stems were tested intraoperatively for stability, well fixed stems were treated with ORIF, regardless of how proximal the fracture extent was. Three patients died before follow-up. The remaining 20 patients were followed until union, reoperation, or a minimum of one year with a mean follow up of 24 months. Results 20 of 20 (100%) fractures united. Three patients developed a surgical complication. There were 3 deep infections (one treated successfully with a DAIR, one with plate removal after bony union, and one treated with resection) There was one dislocation closed reduced with no further instability. There were no cases of plate breakage or trochanteric escape. Conclusions ORIF of extremely proximal fractures around well-fixed femoral components resulted in a high rate of bony union. The rate of postoperative infection was concerning, possibly related to the frail, very elderly population (mean age 83 years) sustaining these rare fracture patterns.