From the Guidelines
Surgical intervention with open reduction and internal fixation (ORIF) is the primary treatment approach for managing periprosthetic radial shaft fractures, prioritizing fracture stability and implant retention or revision based on individual case factors. The management of these fractures is complex and requires a multidisciplinary approach, considering the type of implant, fracture location, and bone quality.
- Key considerations include:
- Fracture stability, which is crucial for bone consolidation and eradication of infection, as emphasized in the study on fracture-related infection 1
- Implant retention or revision, depending on factors such as the ability to perform proper debridement and the type of implant used, with studies suggesting higher treatment failure rates with intramedullary nails compared to plate osteosynthesis 1
- The timing of intervention, with success rates of implant retention decreasing over time, particularly beyond 10 weeks after fracture fixation 1
- Surgical techniques may involve:
- Plate fixation with locking screws for stable implants with adequate bone stock
- Revision arthroplasty with a longer stem prosthesis for loose implants or fractures extending into the implant interface
- Supplemental plate fixation or cerclage wiring in complex cases
- Bone grafting (autograft or allograft) for severely comminuted fractures with poor bone quality
- Postoperative care includes immobilization, progressive rehabilitation, and individualized weight-bearing restrictions, aiming to optimize fracture healing and functional outcomes while minimizing complications.
From the Research
Management of Periprosthetic Radial Shaft Fractures
There are no research papers to assist in answering this question as the provided studies focus on periprosthetic fractures around the knee, femur, and humerus, but not specifically on periprosthetic radial shaft fractures.
Related Information on Periprosthetic Fractures
- Various fixation strategies have been used in periprosthetic fractures, including intramedullary nails, locked plates, unicortical locking screws, cerclage wires and cables, double-plating techniques, and allograft struts 2
- Less invasive polyaxial locking plate fixation has been used in the treatment of periprosthetic and peri-implant fractures of the femur, with low rates of soft-tissue complication and implant failure 3
- Locking attachment plate fixation has been used around a well-fixed stem in periprosthetic femoral shaft fractures, yielding acceptable outcomes 4
- Surgical treatment of periprosthetic fractures around the knee should be based on diagnostics, classification and planning, surgical technique, and rehabilitation 5
- Postoperative periprosthetic humeral shaft fractures can be treated with nonoperative management or surgical intervention, including open reduction and internal fixation, revision arthroplasty, or hybrid fixation 6