Retrograde intramedullary nailing below a hip arthroplasty prosthesis: a viable fixation option for periprosthetic and interprosthetic femur fractures

Background Periprosthetic femur fractures (PPFF) distal to a femoral stem are traditionally treated with open reduction and internal fixation (ORIF) with plate and screws. To our knowledge, no studies exist comparing outcomes following ORIF vs retrograde intramedullary nails (RIMN) for this injury. Methods This is a retrospective comparison of PPFFs distal to a femoral stem treated by ORIF ( n = 17) vs RIMN ( n = 13). The primary outcome was unplanned re-operation. Results There was no difference in unplanned re-operation (17.6 vs 23.1%, p > 0.99), infection, nonunion, refracture, and alignment between groups. The RIMN group had shorter surgical time (89 vs 157 min, p < 0.01), less blood loss (137 vs 291 ml, p = 0.03), and greater obesity. Conclusion RIMN is a potential option for operative fixation of PPFF distal to a femoral stem worthy of additional study.