{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:55Z","timestamp":1787028655194,"version":"build-2736575974"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,5]],"date-time":"2025-01-05T00:00:00Z","timestamp":1736035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Hip fractures are prevalent among the elderly and impose a significant burden on healthcare systems due to the associated high morbidity and costs. The increasing use of intramedullary nails for hip fracture fixation has inadvertently introduced risks; these implants can alter bone elasticity and create stress concentrations, leading to peri-implant fractures. The aim of this study is to investigate the outcomes of peri-implant hip fractures, evaluate the potential causes of such fractures, determine the type of treatment provided, assess the outcomes of said treatments, and establish possible improvement strategies. Methods: We conducted a retrospective observational study on 33 patients with peri-implant hip fractures (PIFs) who underwent surgical management at R\u00edo Hortega University Hospital from 2010 to 2022. The collected data included demographics, initial fracture characteristics, the peri-implant fracture classification, implant details, surgical outcomes, functional scores, and complications. Functional capacity was evaluated using the Parker Mobility Score (PMS). Results: The cohort (91% female, mean age 87.6 years) included 34 peri-implant fractures. The mean time from the initial fracture to the PIF was 47.2 months (nine patients developed PIFs within 2 months). Most fractures (76%) were managed with implant removal and the insertion of a long intramedullary nail, with cement augmentation in 31% of cases. The mean surgical time was 102 min, and the average hospital stay was 9.6 days. Postoperative complications occurred in 27%, with a perioperative mortality rate of 9%. Functional capacity showed a significant decline, with an average PMS loss of 4.16 points. Mortality at one year post-PIF was 36%, rising to 83% at five years. Radiographic consolidation was observed in 72% of cases at an average of 6.04 months, though 24% of patients died before consolidation. Statistically significant correlations were found for PMS pre-index fracture (PMS1: r = 0.354, p &lt; 0.05), pre-PIF (PMS2: r = 0.647, p &lt; 0.001), and post-PIF (PMS3: r = 0.604, p &lt; 0.001). Conclusions: Peri-implant hip fractures present complex challenges due to their surgical difficulty and impact on patient mobility and survival. Successful management requires individualized treatment based on fracture type, implant positioning, and patient factors. These findings underscore the need for preventive measures, particularly in implant choice and techniques like overlapping and interlocking constructs, to minimize the secondary fracture risk.<\/jats:p>","DOI":"10.3390\/jcm14010261","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T06:43:04Z","timestamp":1736145784000},"page":"261","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical and Functional Outcomes of Peri-Implant Fractures Associated with Short Proximal Femur Nails: Prevention Strategies and Key Insights"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2075-5019","authenticated-orcid":false,"given":"Ignacio","family":"Aguado-Maestro","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, R\u00edo Hortega University Hospital, C Dulzaina 2, 47012 Valladolid, Spain"},{"name":"Discipline of Orthopaedics, Faculty of Medicine, University of Valladolid, Av Ram\u00f3n y Cajal 7, 47007 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Valle-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, R\u00edo Hortega University Hospital, C Dulzaina 2, 47012 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3858-0325","authenticated-orcid":false,"given":"Clarisa","family":"Sim\u00f3n-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Discipline of Orthopaedics, Faculty of Medicine, University of Valladolid, Av Ram\u00f3n y Cajal 7, 47007 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5944-5886","authenticated-orcid":false,"given":"Emilio-Javier","family":"Frutos-Reoyo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Physical Medicine, R\u00edo Hortega University Hospital, C Dulzaina 2, 47012 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3607-1247","authenticated-orcid":false,"given":"Ignacio","family":"Garc\u00eda-Cepeda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, R\u00edo Hortega University Hospital, C Dulzaina 2, 47012 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00e9s","family":"de Blas-Sanz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, R\u00edo Hortega University Hospital, C Dulzaina 2, 47012 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6683-9093","authenticated-orcid":false,"given":"Ana-Elena","family":"Sanz-Pe\u00f1as","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, R\u00edo Hortega University Hospital, C Dulzaina 2, 47012 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Diez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, R\u00edo Hortega University Hospital, C Dulzaina 2, 47012 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan-Pedro","family":"Menc\u00eda-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Discipline of Orthopaedics, Faculty of Medicine, University of Valladolid, Av Ram\u00f3n y Cajal 7, 47007 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Sanz-Posadas","sequence":"additional","affiliation":[{"name":"Discipline of Physiotherapy, Faculty of Health Sciences, European University Miguel de Cervantes, C del Padre Julio Chevalier 2, 47012 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,5]]},"reference":[{"key":"ref_1","unstructured":"Baixauli Garc\u00eda, F., Cancio Trujillo, J., Cuadra Llopar, L., Ojeda Thies, C., and Ramos Pascua, L. (2022). Epidemiolog\u00eda de la fractura de cadera. Gu\u00eda de Buena Pr\u00e1ctica Cl\u00ednica en Geriatr\u00eda Atenci\u00f3n al Adulto Mayor con Fractura de Cadera., SECOT (Spanish Society of Orthopaedic Surgery and Traumatology)."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00264-005-0026-2","article-title":"Epidemiology of osteoporotic hip fractures in Spain","volume":"30","author":"Herrera","year":"2006","journal-title":"Int. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"372","DOI":"10.2106\/00004623-200203000-00007","article-title":"Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: A prospective, randomized study","volume":"84","author":"Sadowski","year":"2002","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_4","first-page":"712","article-title":"Intertrochanteric fractures: Ten tips to improve results","volume":"91","author":"Haidukewych","year":"2009","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3647","DOI":"10.1007\/s11999-015-4469-5","article-title":"Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons","volume":"473","author":"Niu","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_6","first-page":"163","article-title":"Utilization Trends, Patient-Demographics, and Comparison of Medical Complications of Sliding Hip Screw or Intramedullary Nail for Intertrochanteric Fractures: A Nationwide Analysis from 2005 to 2014 of the Medicare Population","volume":"43","author":"Vakharia","year":"2023","journal-title":"Iowa Orthop. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/BOT.0000000000000784","article-title":"Interprosthetic and Peri-Implant Fractures: Principles of Operative Fixation and Future Directions","volume":"31","author":"Liporace","year":"2017","journal-title":"J. Orthop. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.injury.2018.10.042","article-title":"Proposal for the classification of peri-implant femoral fractures: Retrospective cohort study","volume":"50","author":"Videla","year":"2019","journal-title":"Injury"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1016\/j.injury.2016.04.042","article-title":"Peri-implant femoral fractures: The risk is more than three times higher within PFN compared with DHS","volume":"47","author":"Galler","year":"2016","journal-title":"Injury"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1302\/0301-620X.96B6.34040","article-title":"The Unified Classification System (UCS): Improving our understanding of periprosthetic fractures","volume":"96","author":"Duncan","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s00402-018-2905-1","article-title":"Non-prosthetic peri-implant fractures: Classification, management and outcomes","volume":"138","author":"Chan","year":"2018","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/BOT.0000000000001499","article-title":"Previous Implant Fractures: A New Descriptive Classification System","volume":"33","author":"Egol","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1530\/EOR-23-0105","article-title":"Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators\u2019 recommendations","volume":"9","author":"Aguado","year":"2024","journal-title":"EFORT Open Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1016\/j.injury.2021.04.021","article-title":"A pilot agreement study of a new classification system for Peri-implant femoral fractures","volume":"52","author":"Videla","year":"2021","journal-title":"Injury"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1302\/0301-620X.79B6.0790969","article-title":"Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip","volume":"79","author":"Baumgaertner","year":"1997","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.2106\/00004623-195941080-00003","article-title":"A ten-year analysis of intertrochanteric fractures of the femur","volume":"41","author":"Cleveland","year":"1959","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.injury.2019.10.035","article-title":"Validation of the Fracture Mobility Score against the Parker Mobility Score in hip fracture patients","volume":"51","author":"Voeten","year":"2020","journal-title":"Injury"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s00068-020-01596-7","article-title":"Peri-implant femoral fractures in hip fracture patients treated with osteosynthesis: A retrospective cohort study of 1965 patients","volume":"48","author":"Kruse","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg. Off. Publ. Eur. Trauma Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1016\/j.annfar.2011.08.010","article-title":"Fracture de l\u2019extr\u00e9mit\u00e9 sup\u00e9rieure du f\u00e9mur du patient \u00e2g\u00e9: Aspect \u00e9pid\u00e9miologique, facteurs de risque","volume":"30","author":"Aubrun","year":"2011","journal-title":"Ann. Fr. Anesth. R\u00e9animation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.injury.2018.01.001","article-title":"Mortality in patients sustaining a periprosthetic fracture following a previous extracapsular hip fracture fixation","volume":"49","author":"Jennison","year":"2018","journal-title":"Injury"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.otsr.2014.07.023","article-title":"Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis","volume":"100","author":"Ma","year":"2014","journal-title":"Orthop. Traumatol. Surg. Res. Orthop. Traumatol. Surg. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1007\/s00402-020-03739-2","article-title":"Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis","volume":"141","author":"Farrow","year":"2021","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/BOT.0000000000001553","article-title":"Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study","volume":"33","author":"Shannon","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.injury.2020.09.037","article-title":"Biomechanical analysis of peri-implant fractures in short versus long cephalomedullary implants following pertrochanteric fracture consolidation","volume":"52","author":"Breceda","year":"2021","journal-title":"Injury"},{"key":"ref_25","first-page":"82","article-title":"Is the risk of secondary peri-implant fracture after trochanteric consolidation similar when using short or long TFNA?","volume":"102","author":"Zderic","year":"2020","journal-title":"Orthop. Proc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"304","DOI":"10.3928\/01477447-20220511-03","article-title":"Risk of Peri-implant Fracture With Long Versus Short Cephalomedullary Nailing for Geriatric Patients With Intertrochanteric Femur Fracture","volume":"45","author":"Sop","year":"2022","journal-title":"Orthopedics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1007\/s00402-021-03752-z","article-title":"Short versus long cephalomedullary nailing of intertrochanteric fractures: A meta-analysis of 3208 patients","volume":"142","author":"Cinque","year":"2022","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.injury.2016.02.009","article-title":"Distal locking in short hip nails: Cause or prevention of peri-implant fractures?","volume":"47","author":"Waldauf","year":"2016","journal-title":"Injury"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/261\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:23:05Z","timestamp":1759918985000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/261"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,5]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14010261"],"URL":"https:\/\/doi.org\/10.3390\/jcm14010261","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,5]]}}}