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These fractures create major clinical and surgical challenges, driven by implant instability, reduced bone quality, and higher morbidity and mortality. The Vancouver classification system guides fracture classification and management using factors such as fracture location, implant stability, and bone stock. The review synthesizes epidemiology and risk factors, details Vancouver subtypes and treatment strategies, and discusses emerging fixation innovations and future directions.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/periprosthetic-proximal-femoral-fractures-a-comprehensive-review-of-epidemiology-risk-factors-classification-and-management/418478/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/periprosthetic-proximal-femoral-fractures-a-comprehensive-review-of-epidemiology-risk-factors-classification-and-management/418478.png","ImageObject",300,407,{"name":92,"@type":93},"Jacob","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What makes periprosthetic proximal femoral fractures (PPFFs) clinically challenging?","Question",{"text":112,"@type":113},"PPFFs are linked to implant instability and compromised bone quality, leading to significant surgical complexity and worse patient outcomes, including increased morbidity and mortality.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the Vancouver classification guide PPFF management?",{"text":117,"@type":113},"It classifies fractures by location, implant stability, and bone stock quality, which then informs treatment decisions and surgical planning.",{"name":119,"@type":110,"acceptedAnswer":120},"What risk factors are associated with PPFFs?",{"text":121,"@type":113},"Risk factors include patient-related factors (e.g., advanced age, female sex, osteoporosis/low bone mineral density, comorbidities) and implant-related factors such as prosthesis type and fixation method.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},418478,1790664879,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},962084931830,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Review began 11/20/2025  \nReview ended 12/25/2025  \nPublished 01/01/2026  \n© Copyright 2026  \nFoster et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.100589  \nOpen Access Review Article  \nPeriprosthetic Proximal Femoral Fractures: A Comprehensive Review of Epidemiology, Risk Factors, Classification and Management  \nAndrew Foster 1, Mohammad Waseem Beeharry 1  \n1. Trauma and Orthopaedics, Royal Surrey NHS Foundation Trust, Surrey, GBR  \nCorresponding author: Mohammad Waseem Beeharry, [m.w.beeharry@doctors.org.uk](m.w.beeharry@doctors.org.uk)  \nAbstract  \nPeriprosthetic proximal femoral fractures (PPFFs) represent an increasingly prevalent complication following hip arthroplasty, driven by global demographic shifts and rising arthroplasty rates. These fractures pose significant clinical and surgical challenges due to their association with implant instability, compromised bone quality, and increased patient morbidity and mortality. The Vancouver classification system remains the cornerstone for fracture classification and management decision-making, distinguishing fractures by location, implant stability, and bone stock quality.  \nThis review outlines the epidemiology and risk factors associated with PPFFs, highlighting both patientrelated factors, such as advanced age, female sex, osteoporosis, and comorbidities, and implant-related factors, including prosthesis type, fixation method, stem sizing, and surgical approach. Each fracture subtype within the Vancouver classification is discussed, with emphasis on appropriate surgical strategies ranging from conservative management to complex revision arthroplasty.  \nRecent innovations in surgical fixation, including angle-stable and double plating, offer improved biomechanical stability and enhanced union rates. Furthermore, advances in 3D printing and artificial intelligence hold promise for custom implant design and data-driven treatment planning. Novel techniques, such as transprosthetic drilling with internal cooling systems, may further address fixation challenges in complex cases.  \nAs the burden of PPFFs continues to grow, a comprehensive understanding of risk stratification, evidencebased treatment, and emerging technologies is essential to improve outcomes and optimize healthcare resource utilization.  \nCategories: Trauma, Orthopedics  \nKeywords: femoral, femur, fracture, implant, periprosthetic, periprosthetic proximal femoral fractures, ppff, vancouver classification  \nIntroduction And Background  \nPeriprosthetic proximal femoral fractures (PPFFs) refer to fractures occurring in the region of the femur surrounding or adjacent to a femoral implant, most commonly following primary or revision hip arthroplasty. These injuries typically involve the proximal femur and may compromise implant stability, bone stock, and overall hip function.  \nThey are a growing clinical concern, largely due to the rising number of hip arthroplasty procedures being performed. As the population ages and the demand for joint replacements increases, the incidence of these fractures is expected to continue climbing. The incidence of periprosthetic femoral fractures (PFFs) following primary total hip replacement (THR) is currently estimated at 3.5%, with projections indicating an increase of approximately 4.6% per decade over the next 30 years. According to data from the UK National Joint Registry, PFFs are the third most common indication for revision surgery, and the number of revisions performed for this indication has nearly doubled since 2013 [1] .  \nPFFs pose complex reconstructive challenges and are associated with significant patient morbidity, including prolonged hospital stays, impaired mobility, and increased mortality rates [2] . Timely diagnosis and a thorough un","cbCaidFlolm0UrnW","https://ap.wps.com/l/cbCaidFlolm0UrnW","pdf",174733,"English","# Abstract\n# Introduction And Background\n# Review\n## Epidemiology\n## Risk factors","[{\"question\":\"What makes periprosthetic proximal femoral fractures (PPFFs) clinically challenging?\",\"answer\":\"PPFFs are linked to implant instability and compromised bone quality, leading to significant surgical complexity and worse patient outcomes, including increased morbidity and mortality.\"},{\"question\":\"How does the Vancouver classification guide PPFF management?\",\"answer\":\"It classifies fractures by location, implant stability, and bone stock quality, which then informs treatment decisions and surgical planning.\"},{\"question\":\"What risk factors are associated with PPFFs?\",\"answer\":\"Risk factors include patient-related factors (e.g., advanced age, female sex, osteoporosis/low bone mineral density, comorbidities) and implant-related factors such as prosthesis type and fixation method.\"}]","Periprosthetic Proximal Femoral Fractures - A Comprehensive Review of Epidemiology, Risk Factors, Classification and Management | PDF",1790613337]