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Intraoperative Periprosthetic Fractures in Proximal Interphalangeal Joint Arthroplasty
Eric R Wagner1, Robert Van Demark1, Daryl J Kor2
1Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Purpose:
To examine the frequency, risk factors, and postoperative outcomes associated with intraoperative periprosthetic fractures during proximal interphalangeal (PIP) joint arthroplasty.
Methods:
We examined 382 consecutive PIP joint arthroplasties in 205 patients. Procedures were performed from 1998 to 2012. The patients were identified and outcomes were collected through a single institution's total joints registry, collecting additional information not contained in the prospectively collected registry through medical record examination. Multiple outcomes were analyzed relating to the fractures, the hard surgical outcomes, finger function, and radiographic findings. Statistical analysis was performed utilizing Kaplan-Meier survival models, log-rank tests, univariate analysis, Student t test and Fisher exact test.
Results:
Intraoperative periprosthetic fracture occurred in 5% (n = 20) of 383 PIP joint arthroplasties. All of the patients who had an intraoperative fracture were women. Lower body mass index and a diagnosis of rheumatoid arthritis were associated with a significantly higher risk of intraoperative fracture. The use of pyrocarbon implants also significantly increased fracture risk. At a median follow-up of 5.3 years, there were no refractures in the patients who sustained an intraoperative fracture. Six patients underwent revision surgery, with a 2- and 5-year survival rate free of revision surgery of 76% and 64%, respectively. These rates were not significantly different from those without intraoperative fractures. There was no significant difference in the incidence of postoperative complications between patients with or without an intraoperative fracture.
Conclusions:
Intraoperative fractures occur in about 5% of PIP joint arthroplasties. These periprosthetic fractures do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications. Female sex, lower body mass index, rheumatoid arthritis, and the use of pyrocarbon implants were associated with increased risk for intraoperative fractures.
Clinical Relevance:
This information may help decrease fracture risk and help surgeons identify and treat the fractures when they do occur.
Type Of Study/Level Of Evidence:
Prognostic II.
