Periprosthetic fractures: A growing challenge for surgeons

EFORT ExMEx Periprosthetic Fractures, Barcelona, 16th – 17th March 2012

Periprosthetic fractures: A growing challenge for surgeons

An EFORT ExMEx Forum dedicated to meeting challenges in the treatment of periprosthetic fractures will be held in Barcelona from 16th to 17th March 2012. Renowned experts will be on the scene both to update participants about the current state of science as well as to demonstrate the practical use of latest techniques and methods in the care of these increasingly common fractures.

The prevalence of periprosthetic fractures is on the rise. This is partly due to continuously increasing life expectancy, which entails more people receiving artificial hip or knee implants. Some of these periprosthetic fractures occur in older people because they have – for various reasons – an increased tendency to suffer from falls. “While bone substance is still elastic in younger people, it is more frequently subject to fracture in older people. If artificial joints are involved, these fractures are all the more complicated,” says Professor Dr Norbert Haas of the Charité Centre for Musculoskeletal Surgery in Berlin (Germany), Chairman of the EFORT Trauma Task Force.

Treating such fractures is not only technically very demanding; it requires a completely different approach than the treatment of a conventional fracture. Precisely such special challenges make up the central focus of the ExMEx Forum “Periprosthetic Fractures” that EFORT is organising in Barcelona next March.

Elucidating the topicality of the event’s subject matter, Dr Josep M. Muñoz Vives from Spain’s Hospital Universitario de Girona and Chairman ExMEx Barcelona explains that “periprosthetic fractures are so difficult to treat because part of the bone is no longer made of bone substance, but of a composite material such as steel or titanium.”

The first step in the successful treatment of a periprosthetic fracture is the precise analysis of each case. “Every fracture is different and requires an individual approach,” says Professor Haas. Therefore – in addition to introductory lectures on the state-of-the-art – individual case discussions will also be a main focus of this Forum. Course participants will improve their ability to analyse a particular case and to decide on the proper course of action. “If you do not adequately master that, you may encounter serious difficulties during the operation,” Professor Haas continues. A crucial element before starting the surgery is to know whether the prosthesis is still firmly in place or whether it has become loose as a result of the fracture. This is a decisive piece of information that determines the choice of surgical technique.

A portion of the course is also devoted to modern fracture stabilisation techniques that have been developed in recent years. Responding to an increasing demand, the medical technical industry has recently come up with several new tools that are well suited for the treatment of periprosthetic fractures. Minimally invasive surgery decreases the impact on a patient weakened by age, angular stable implants increase fixation in the osteoporotic bone and the recently introduced polyaxial implants, which are flexible and no longer require implantation in a certain direction, make it possible to bypass the prosthesis. All these techniques have brought enormous improvements. How these methods and techniques can be applied in challenging fractures will be discussed in detail within the framework of the Barcelona ExMEx.

Furthermore, femoral fractures are an important topic on the agenda of the forthcoming course. They are the most common fractures in patients with hip or knee joint prostheses. All aspects of the successful management of these fractures will be thoroughly discussed.

Another particular challenge for orthopaedic and trauma surgeons are fractures over loosened prostheses. “Of course, you have to revise the replacement, remove the loosened prosthesis and implant a new one, but new methods also permit the treatment of the broken bone with the same implant with modular stems that bridge the fracture,” says Dr Muñoz Vives in describing new techniques to which considerable time is being devoted on the agenda of the ExMEx Forum.

Fractures that are accompanied by infections can also pose serious difficulty in treatment. There is a range of individual solutions which will also be explored in detail at the upcoming event.
“The EFORT ExMEx Forum on periprosthetic fractures is aimed at experienced orthopaedic and trauma surgeons not only keen to improve their knowledge, but who want to share their own knowledge as well. Knowledge transfer will be multi-directional,” says Dr Muñoz Vives in defining the target group of the event. “We have tried to put together a challenging and interactive programme and look forward to welcoming many interested colleagues from all over Europe in Barcelona in March 2012.”

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