For a periprosthetic fracture, what is the typical management?

• A. Antibiotics alone
• B. Observation
• C. Fixation or revision
• D. Physical therapy only

Answer: (C)

When a fracture occurs around a joint prosthesis, the priority is to restore stability of both the fracture and the implant so the joint can function properly and the prosthesis remains secure. The typical approach is to fix the fracture if the existing implant is well-fixed and there is usable bone stock, using plates, screws, and often cerclage wires, sometimes with bone grafting to promote healing. If the prosthesis itself is loose or the bone quality is poor, revision arthroplasty with a longer stem or a more robust prosthesis is usually required to provide durable stability and correct alignment. Antibiotics alone cannot address fracture stability, observation is rarely appropriate because of the risk of displacement and potential prosthesis loosening, and physical therapy by itself won’t stabilize a fracture around a prosthesis. The aim is to reestablish a stable, functional knee or hip (or other joint) with the ability to bear weight as safely and as early as possible.