Artificial Fractures: Towards a Unified Terminology for Implant‑Influenced Fractures

Background: Orthopedic implants are increasingly used in both trauma and reconstruc-tive surgery. Fractures occurring in the presence of implants are currently described with multiple terms (periprosthetic, peri-implant, hardware-related, implant-associated), lea-ding to inconsistent communication. Objective: To systematically review the existing terminology, quantify its heterogeneity, and evaluate the rationale for a unified umbrella concept. Methods: A systematic literature search was performed across PubMed, Scopus, and Web of Science (2000–2023) using predefined keywords. Inclusion criteria were clinical studies, reviews, or consensus papers that used or discussed terminology for fractures related to orthopedic implants. Data on terminology, anatomical site, and year of publication were extracted. A bibliometric frequency analysis was conducted. Results: Of 1,142 records screened, 184 met inclusion criteria. The terms “periprosthetic fracture” (68%), “implant-related fracture” (14%), “peri-implant fracture” (9%), and “hardware-related fracture” (7%) were most frequent, with substantial variation by ana-tomical site (hip: 52%, knee: 19%, shoulder: 11%, spine: 8%, trauma fixation devices: 10%). Historical consensus groups (AO/OTA, ISFR, ICS) have debated umbrella terms but re-jected them due to concerns about ambiguity. Discussion: Current terminology is fragmented, site-specific, and inconsistently applied. We propose the descriptive label “artificial fracture” to denote any fracture in which the biomechanics, morphology, or management are significantly influenced by the presence of an implant. This concept is intended as a transversal descriptor to complement, not re-place, existing classification systems. Conclusion: Standardized terminology may improve interdisciplinary communication, research comparability, and registry documentation. Future validation should include Delphi surveys, stakeholder engagement, and consensus endorsement.