The bridging nail in periprosthetic fractures of the hip: Incidence, biomechanics, histology and clinical outcomes

Periprosthetic fractures of the femur are a challenging problem. Especially in geriatric, frail patients the development of complications has a large effect on health. Due to increased numbers of performed total hip arthroplasties and the longer life-expectancy, the incidence of these fractures is expected to rise. The incidence of periprosthetic fractures in The Netherlands was estimated, using data of Dutch hospital admissions. A questionnaire on periprosthetic fracture treatment by Dutch orthopaedic surgeons revealed a diversity of preferred treatment strategies. A large clinical retrospective study demonstrated high complication rates and re-operations leading to increased morbidity and mortality. A clinical outcome score was used to evaluate function. An operative treatment alternative in frail patients is the Bridging nail. This intramedullary nail offers connectivity between the stem of the prosthesis. It provides femoral stability at weight bearing loads, evaluated by laboratory testing. The clinical follow up showed consolidation of all periprosthetic fractures. Normal fracture healing and no adverse corrosion effects were seen in a histological retrieval case-study. A number of patients showed advantages of early ambulation and from the less invasive procedure in the treatment of fractures below intramedullary nails. The Bridging nail can serve as a treatment in frail periprosthetic fracture patients