Current Practice of Italian Association of Revision Surgery Members in the Treatment of Unified Classification System Type B Periprosthetic Femoral Fracture Around Hip Arthroplasty: A Cross-Sectional Survey

Abstract

Introduction Periprosthetic femoral fracture around hip arthroplasty are growing in the world, nevertheless management and treatment options for fractures “around the stem” are still debated due to lack of high-level studies. Materials and method A 85-item survey were fill out by 40 Italian Orthopedic Surgeon member of SIOT (Società Italiana di Ortopedia e Traumatologia) and AIR (Associazione Italiana Riprotesizzazione) to assess their current opinion in the management of type B periprosthetic femoral fractures. Responses were summarized using proportions, and further stratified by practice type, case volume, surgeon age, and fellowship training. Results Vancouver/UCS fracture classification showed a good interobserver agreement (k value = .76). ORIF were the treatment of choice for UCS type B1 fractures (100%), revision stem for B2 (85%) and B3 (100%). Locked plates were preferred to cable plate and cerclage without a plate for B1 fractures (50% vs 40% vs 10%); revision with modular stem was preferred to monoblock stem for B2 fractures (50% vs 35%) and B3 (75% vs 15%). Responders tended to postpone at 1-month weight-bearing in patients with B1 fractures. Regarding postoperative pharmacological treatment there was absolute lack of consensus. Discussion The primary finding of our survey confirmed the preference of ORIF for B1 fractures and stem revision for B2 and B3 fractures. However, there is no definitive operative technique for all UCS B fractures. Surgeons tended to favor locked plating over cable plating, although only slightly. This general lack of consensus coincides with the inconclusive evidence that currently exists in the literature, which demonstrates both favorable and unfavorable outcomes for both techniques Conclusions The absence of complete homogeneity among participants showed the need for prospective randomized studies to set up stronger guidelines for classification, management, surgical treatment, rehabilitation, and pharmacological support of periprosthetic femoral fractures.

Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures: Insights from a Comprehensive Case Series Analysis

“…The Vancouver classification system, which is commonly employed to guide treatment choices, demonstrated a satisfactory degree of agreement among observers for Unified Classification System (UCS) type B fractures (k=0.76). Nonetheless, the differentiation between B1 and B2 fractures presents difficulties as a result of constraints in preoperative X-ray assessments (k=0.64) [16].…”

Insights from a Comprehensive Case Series Analysis: Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures

“…The Vancouver classification system, which is commonly employed to guide treatment choices, demonstrated a satisfactory degree of agreement among observers for UCS type B fractures (k=0.76). Nonetheless, the differentiation between B1 and B2 fractures presents difficulties as a result of constraints in preoperative X-ray assessments (k=0.64) [16].…”

The History of Classification Systems for Periprosthetic Femoral Fractures: A Literature Review

“…Most recently, several studies revealed that revision surgery was the most common approach for Type B2/B3 fractures, while simple fixation prevailed as the predominant strategy for Type B1/C fractures. 90 , 91 , 92 Furthermore, Thomas et al . reported that monoblock tapered stems can be an acceptable modality in the treatment of Type B2 fractures, while Capone et al .…”

“…90-92 Furthermore, Thomas et al reported that monoblock tapered stems can be an acceptable modality in the treatment of Type B2 fractures, while Capone et al indicated that for Type B2 and B3 fractures, revision with modular stems is preferable to monoblock stems. 91,93 A multicenter study has indicated that for Type B fractures around cemented polished taper-slip femoral components, ORIF is associated with lower reoperation rates, shorter waiting times for surgery, reduced transfusion needs, and lesser demands for critical care compared to revision surgery. 94 Conversely, research by Scalici et al found that patients with Type B and C fractures undergoing revision surgery had better functional outcomes than those treated with ORIF.…”

“…The treatment principles of Type A, B and C in UCS were the same as those in VCS. Most recently, several studies revealed that revision surgery was the most common approach for Type B2/B3 fractures, while simple fixation prevailed as the predominant strategy for Type B1/C fractures 90–92 . Furthermore, Thomas et al .…”