OBJECTIVES: Periprosthetic fractures (PPFx), breaking of the bone around a prosthetic joint implant, are one of the most serious complications in total joint replacements. PPFx can be managed surgically with open reduction and internal fixation (ORIF) or revision total joint arthroplasty (rTJA). The purpose of this study is to examine incidence and comparative in-hospital outcomes for the management of PPFx. METHODS: Data from the 2002-2013 Nationwide Inpatient Samples were analyzed. Patients with PPFx were identified with International Classification of Diseases, 9^th Revision, Clinical Modification (ICD-9-CM) diagnosis code 996.44. The management strategy for the PPFx was identified using ICD-9-CM procedure codes for ORIF (79.35) and rTJA (00.70-00.73, 00.80-00.85, 81.53, and 81.55). Length of stay, incidence of major and minor surgical complications, and in-hospital mortality were also examined. RESULTS: A total of 12,763 PPFx managed with ORIF (N=6,545; 51.3%) or rTJA (N=6,218; 48.7%) were identified (70.8% female, Median Age: 76 years [IQR: 66-84]), representing an average estimated national annual incidence of 6,820 cases. During the study period, there were 966 in-hospital deaths associated with PPFx. Ten-percent (N=1,320) of patients experienced minor complications and six-percent (N=777) experienced major complications. Patients undergoing rTJA for PPFx were over twice as likely to experience major complications (OR=2.29 [1.96-2.67], p<0.01) than ORIF patients and 30% more likely to experience minor complications (OR=1.28 [1.14-1.44], p<0.01), but no more likely to die during the hospitalization (p=0.20), despite being slightly younger (74 vs 78 years, p<0.01). On average, both patient populations stayed an average of 6 days in hospital (IQR=4-8 days; p=0.23). CONCLUSIONS: Approximately 1 in 20 PPFx patients experience major in-hospital complications, while 1 in 10 will experience minor in-hospital complications. In hospital mortality is 1 in 120, though previous research suggests that up to 1 in 10 patients will die within one year of surgical treatment for PPFx.