Treatment of Vancouver type B2 periprosthetic femoral fractures

Haasper, Carl; Enayatollahi, Mohammad Ali; Gehrke, Thorsten

doi:10.1007/s00264-015-2959-4

Cited by 16 publications

(8 citation statements)

References 27 publications

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“…1,2 This tendency is expected to continue, leading to a likewise increase in periprosthetic femoral fractures as it may occur in 0.07% to 18% after hip arthroplasty. [3][4][5] Risk factors for postoperative periprosthetic femoral fractures are advanced age, osteoporosis, rheumatoid arthritis, proximal femur deformities, previous hip surgery, stems implanted without the use of cement and press-fit implantation, cortical perforation during surgery, stem loosening, and revision arthroplasty (RA). 4,6 The Vancouver classification introduced by Duncan and Masri is currently the most widely used classification system for periprosthetic femoral fractures.…”

Section: Introductionmentioning

confidence: 99%

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

Baum

Leimbacher

Kriechling

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction:The Vancouver algorithm recommends revision arthroplasty (RA) for Vancouver type B2 (VTB2) fractures. However, open reduction and internal fixation (ORIF) using locking compression plates (LCP) may be a valid and less invasive alternative treatment.Materials and Methods:Between January 2007 and March 2017, we retrospectively recruited all patients treated with either ORIF with LCP or RA for VTB2 fractures in our clinic. All of the following were reviewed: the length of hospital stay, the operating time, the need for blood transfusions during and/or after surgery, implant-related and patient-related complications, need for revision surgery, and the radiological outcome. Additionally, the functional outcome was investigated.Results:Fifty-nine patients were recruited. Thirty-five (59.3%) patients underwent RA, while 24 (40.7%) patients received ORIF with LCP. The median surgical time was 137.50 minutes in the LCP group compared to 160.00 minutes in the RA group ( P = .051). Three (12.5%) patients in the LCP group and 10 (28.6%) patients in the RA group experienced an implant-associated complication ( P = .131). Patient-related complications occurred in 3 (12.5%) patients in the LCP group versus 6 (17.1%) patients in the RA group ( P = .628). The mean preoperative Parker mobility score was 9 points in both groups and decreased in both groups to a mean of 5 points in the LCP and 7 points in the RA group.Discussion:Open reduction and internal fixation with LCP seems to be a less invasive procedure for VTB2 fractures in comparison to RA. It is a bone-sparing procedure that can be advantageous for further revision operations. Moreover, some fractures can only be anatomically reduced by ORIF with LCP, whereas for proximal fractures with a radiologically unambiguously loosened stem RA might be advantageous.Conclusion:In line with previously published studies, our data suggest that ORIF using LCP is a valid treatment option for VTB2 fractures.

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Section: Introductionmentioning

confidence: 99%

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

Baum

Leimbacher

Kriechling

et al. 2019

Geriatr Orthop Surg Rehabil

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“…The incidence of post-operative periprosthetic fractures reported in the literature varies, ranging from less than 1% after primary arthroplasty to up to 4% after revision arthroplasty, and this number appears to be on the rise 3, 4, 5. This is because of increasing patient longevity, more demanding activity levels that persist into advanced age, and the increasing rate of revision arthroplasty 6 . PFF has been associated with significant morbidity and mortality 7, 8.…”

Section: Introductionmentioning

confidence: 99%

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

Park

Hong

Nho

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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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.

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“…It has been validated in cemented stems [17] but has not been able to demonstrate the same validity in uncemented stems [18]. The authors define that an arthroplasty revision should be performed, with a longer stem, despite good bone stock [2,19].…”

Section: Discussionmentioning

confidence: 99%

Is Stem Revision Necessary for Vancouver B2 Periprosthetic Hip Fractures? Analysis of Osteosynthesis Results from 39 Cases

González-Martín

González-Casamayor

Herrera-Pérez

et al. 2021

JCM

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Although stem revision is recommended for Vancouver B2 periprosthetic hip fractures (PPHFs), there has recently been a debate whether, under certain conditions, they could be treated by osteosynthesis alone. This study aimed to describe the medium-term clinical and radiological results of several patients with V-B2 fractures treated via osteosynthesis. A retrospective study of patients with V-B2 PPHF treated by osteosynthesis without stem revision, operated on between 2009 and 2019, was performed. The type of arthroplasty, type of stem, ASA, Charlson Comorbidity Index (CCI), medical and implant complications, reoperation rate, first-year mortality, radiological results (consolidation time), and functional results were analyzed. Thirty-nine patients were included. Their average age was 78.82 years. Most of the patients presented ASA ≥ 3 (35/39) and CCI ≥ 5 (32/39). Radiological consolidation was achieved in 93.5% of patients, with an average consolidation time of 92.93 days. The average Parker test score before admission was 5.84 while the current one was 4.92 (5.16 years follow-up). Osteosynthesis without stem revision is a valid surgical alternative in certain types of patients with V-B2 PPHF, depending on previous mobility, fracture pattern (anatomical reconstruction possible), anesthetic risk, comorbidities, and previous hip pain.

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Treatment of Vancouver type B2 periprosthetic femoral fractures

Abstract: We recommend performing the procedure only when the surgeon is proficient in revision hip surgery and trauma care. A well-selected portfolio of different stem designs and an array of osteosynthesis devices should be available, as well.

Cited by 16 publications

References 27 publications

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

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

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

Is Stem Revision Necessary for Vancouver B2 Periprosthetic Hip Fractures? Analysis of Osteosynthesis Results from 39 Cases

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