Radiologic outcomes of open reduction and internal fixation for cementless stems in Vancouver B2 periprosthetic fractures

Abstract

ObjectiveThe aim of this study was to evaluate the radiologic outcomes of open reduction and lateral plating with wiring in the treatment of Vancouver B2 periprosthetic femoral fractures.MethodsWe retrospectively recruited 37 patients treated with ORIF with lateral plating and wiring for Vancouver B2 fractures. The 27 patients (15 men and 12 women; mean age: 70.8 ± 8.3 years) without follow-up loss had achieved complete bony union without notable complications. The average union period was checked after operation with radiologic findings. Radiologic outcomes were evaluated by ipsilateral limb length discrepancy (LLD) and subsidence between immediate postoperative length and length at postoperative 1 year after adjusting for magnification differences. The average distance to which the retained stem sunk down was investigated between immediate postoperative radiographs and final radiographs showing union.ResultsTen patients could not be evaluated, because of mortality or failure to follow up. The average time to union was 18.3 weeks, and the average distance of stem sinking was 2.5 ± 1.7 mm (range: 0–7.2 mm), which was significantly different between immediate postoperative radiographs and final radiographs. There was no case with loss of reduction or loss of fixation, requiring revision surgery.ConclusionOpen reduction and lateral plating with wiring as a treatment for Vancouver B2 periprosthetic femoral fractures produced good radiologic outcomes with successful bony union. ORIF can be considered the alternative option for treating patients with Vancouver B2 PPF, instead of stem revision surgery.Level of evidenceLevel IV, Therapeutic study.

Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate

“…However, there was no case with loss of reduction or loss of fixation requiring revision surgery. 33 We presume that with fixation devices such as locking attachment plates and cerclage wires, the osteosynthesis gets further rigidity, and the stem regains stability. Severe subsidence of the prosthesis that leads to persistent pain and revision operations can thereby be avoided in the majority of cases.…”

Management of Vancouver B2 Periprosthetic Femoral Fractures, Revision Total Hip Arthroplasty Versus Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis

“…Six studies published case-by-case data in the form of a table. 14,25,28,29,31,32 All of the included studies were retrospective and all but 2 reported data from a single institution. 10,30 Analysis of the funnel plot calculated using the complication data indicated no evidence of publication bias (see…”

“…Despite emerging observational data on the role of ORIF in B2 management, the overall efficacy and safety are yet to be established in part because of the small sample sizes. 14,15 As such, a systematic review and meta-analysis was designed to establish the current evidence for ORIF in Vancouver B2 patients compared with conventional revision arthroplasty (rTHA). We hypothesized that rTHA as the traditional approach to this problem has more favorable outcomes compared with ORIF in context of a PFF with adequate bone stock and a loose femoral stem.…”

Revision Arthroplasty Versus Open Reduction and Internal Fixation of Vancouver Type-B2 and B3 Periprosthetic Femoral Fractures

“…Subgroup analysis of complications in type-B2 fractures included results from 9 studies 17,20,27,[33][34][35][36][37][38] (27.3%) and involved 104 ORIFtreated and 148 RA-treated patients with a mean follow-up of 3.1 years and 3.5 years, respectively. Again, no significant difference between the 2 groups was observed (21% versus 26%; p 5 0.647).…”