Periprosthetic and peri-implant fractures are critical complications that occur in patients with orthopedic implants, such as joint prostheses or dental implants. These fractures typically arise in the vicinity of a prosthetic device, often due to falls, trauma, or even non-traumatic events related to the stress placed on the surrounding bone. Periprosthetic fractures can occur around knee, hip, and shoulder replacements, while peri-implant fractures are more commonly associated with dental implants. The mechanism of injury may involve various factors, including the patient's bone quality, the stability of the implant, and the forces acting on the surrounding bone. Older patients, particularly those with osteoporosis, are at a higher risk because their bone density is significantly diminished, leading to increased susceptibility to fractures. The clinical presentation of these fractures often includes pain, swelling, and difficulty bearing weight or using the affected limb. Diagnosis typically involves a combination of clinical evaluation and imaging studies like X-rays, which help identify the fracture's location and its relation to the prosthesis or implant. Treatment varies depending on the fracture type, severity, and patient health. It may include non-operative management with bracing and restricted weight-bearing for less severe fractures, or surgical interventions involving fixation or revision of the implant for more complex injuries. Surgical approaches may include using plates, screws, or intramedullary nails to stabilize the fracture. If the implant itself is loose or compromised, revision surgery might be necessary to replace the dysfunctional component. This is particularly crucial in the case of periprosthetic fractures, as improper treatment can lead to complications such as non-union or malunion, which can significantly affect patient outcomes and mobility. Moreover, peri-implant fractures, which can occur in the context of dental implants, may lead to a loss of osseointegration and subsequent implant failure. Prevention strategies focus on optimizing bone health through medications like bisphosphonates or denosumab, fall prevention measures, and ensuring proper implant placement and rehabilitation post-surgery. Additionally, careful surgical planning, including appropriate sizing of implants and alignment, can mitigate the risk of periprosthetic fractures. Overall, the management of periprosthetic and peri-implant fractures is a multifaceted process that requires careful assessment, individualized treatment plans, and consideration of the patient's overall health status and functional goals to optimize recovery and return to normal activities. Careful monitoring and follow-up are also necessary to identify and address any complications early, ensuring the best possible outcomes for patients suffering from these complex orthopedic challenges.
