Fractures of the hip occur frequently in elderly individuals and create a heavy load on healthcare resources owing to elevated morbidity and substantial financial implications. The rising preference for intramedullary nailing in hip fracture repair has inadvertently introduced new hazards; these devices alter bone flexibility and create areas of concentrated stress that may lead to fractures around the implant. This study seeks to analyze the clinical outcomes of peri-implant hip fractures, explore potential contributing factors, identify the treatments administered, evaluate their effectiveness, and suggest ways to enhance future management. A retrospective observational analysis was carried out on 33 patients who experienced peri-implant hip fractures (PIFs) and underwent operative care at Río Hortega University Hospital between 2010 and 2022. The collected information included patient demographics, details of the primary fracture, classification of the peri-implant fracture, characteristics of the implant, surgical findings, functional assessments, and any complications. Functional status was assessed via the Parker Mobility Score (PMS). The study population (91% women, average age 87.6 years) comprised 34 peri-implant fractures. The mean period between the original fracture and the subsequent PIF was 47.2 months, although nine patients sustained a PIF within 2 months. The majority of fractures (76%) were treated by removing the existing implant and replacing it with a long intramedullary nail; cement augmentation was used in 31% of these procedures. The average operative duration was 102 minutes, and the mean length of hospital admission was 9.6 days. Complications after surgery developed in 27% of cases, and the perioperative death rate stood at 9%. Functional ability declined markedly, reflected by an average reduction of 4.16 points on the PMS. One-year mortality following the PIF reached 36% and climbed to 83% by five years. Radiographic union was achieved in 72% of fractures at a mean of 6.04 months, yet 24% of patients passed away before signs of healing. Significant statistical associations were detected with the PMS recorded before the initial fracture (PMS1: r = 0.354, P < 0.05), before the PIF (PMS2: r = 0.647, P < 0.001), and after the PIF (PMS3: r = 0.604, P < 0.001). Peri-implant hip fractures pose demanding clinical problems due to their technical complexity and profound influence on patient movement and long-term survival. Optimal care necessitates a tailored strategy that accounts for the specific fracture pattern, implant location, and individual patient characteristics. The outcomes emphasize the value of prevention, particularly through careful implant selection and the adoption of overlapping or interlocking fixation techniques, to lower the likelihood of secondary fractures.
