Outcomes After Operative Fixation of Vancouver B2 and B3 Type Periprosthetic Fractures

Barghi, Ameen; Hanna, Philip C.; Merchan, Nelson; Lechtig, Aron; Haggerty, Christopher M; Weaver, Michael J.; Keudell, Arvind von; Wixted, John J.; Appleton, Paul; Rodriguez, Edward K.

doi:10.1097/bot.0000000000002277

Cited by 12 publications

(6 citation statements)

References 40 publications

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“…Previous studies have demonstrated that fixation of certain UCS B2 fractures around hips is associated with successful outcomes, decreased blood loss, and shorter time to surgery when compared to revision arthroplasty. 29,30 However, this has not been proven in PPFs around the knee, and further studies are currently required.…”

Section: Discussionmentioning

confidence: 99%

The characteristics and predictors of mortality in periprosthetic fractures around the knee

Nasser,

Sidhu,

Prakash

et al. 2024

Bone Joint J

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AimsPeriprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality.MethodsUsing a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.ResultsOut of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation.ConclusionThe mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.Cite this article: Bone Joint J 2024;106-B(2):158–165.

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Section: Discussionmentioning

confidence: 99%

The characteristics and predictors of mortality in periprosthetic fractures around the knee

Nasser,

Sidhu,

Prakash

et al. 2024

Bone Joint J

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“…Additional research is warranted to establish a more comprehensive classification system that has the potential to enhance the effectiveness of treatment. Recent research has indicated that ORIF may yield positive outcomes, particularly in older populations or individuals with comorbidities [20,21]. As an example, a comprehensive analysis revealed that out of a total of 343 B2 fractures, 86.8% of cases were subjected to revision arthroplasty, while 12.6% were treated solely with ORIF.…”

Section: Discussionmentioning

confidence: 99%

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

Cursaru,

Popa,

Cretu

et al. 2024

Cureus

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The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings of this study emphasize a significant disparity in the occurrence and characteristics of these fractures, and the multiple cases have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the study has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This study provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.

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“…Considering the average Charlson Comorbidity Index [ 10 ] of seven the mortality is equivalent to the literature, which is 28% for a Charlson Comorbidity Index of ≥5 [ 17 ] There was a significantly higher risk for mortality with increasing age. Several studies [ 18 – 20 ] showed no significant difference in the 1-year mortality between open reduction and internal fixation and revision arthroplasty. Furthermore, we could show that there is no significant increase in mortality in Vancouver B3-fracture compared to Vancouver B1- and B2-fractures.…”

Section: Discussionmentioning

confidence: 99%

Operative treatment of periprosthetic fractures of the proximal femur with a contralateral, upside-down LISS plate in elderly patients

Schmid,

Gurschler-Pavotbawan,

Fries

et al. 2023

BMC Geriatr

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Background Increasing expectancy of life and levels of activity in the growing geriatric population lead to a rising number of prosthetic implants of the hip and consequently the incidence of periprosthetic fractures of the femur increase. The fracture pattern and the possible instability of the stem are a challenge to the orthopaedic surgeon. Treatment options are complete replacement of the implant or a solitary osteosynthesis. The goal of this study was to analyse the feasibility of the operative intervention using a contralateral reversed anatomic distal femoral LISS® locking plate and the radiological and functional outcome in a geriatric cohort. Methods We included all patients older than 75 years of age with a Vancouver type B fracture, which have been treated by osteosynthesis using a LISS® (contralateral reversed) plate in our institution in an interdisciplinary ortho-geriatric setting between 7/2013 and 12/2021. Perioperative morbidities, clinical and radiological outcome during follow-up were retrospectively analysed. Results During the observed time period, 83 patients (mean age: 88 years (range: 76–103), male/female: 26/57) were treated. Most fractures were Vancouver type B2 (n = 45, 54%) followed by B1 (n = 20, 24%) and B3 (n = 18, 22%). The most prevalent postoperative surgical complication was anaemia (n = 73, 88%) followed by infections (n = 12, 14%, urinary infections, pneumonia) and cardiovascular decompensation (n = 8, 10%). Clinical and radiological follow up 6–8 weeks postoperative was possible for 59 patients (70%). The majority of them did not describe pain (n = 50, 85%) and had a good or excellent radiological outcome. Three cases needed revision surgery due to infection and another three due to non-union, loosening of the stem or an additional fracture. 1-year mortality was 30%. Conclusion We are convinced that the reversed contralateral LISS-plate is an easy-to-use implant with a small complication rate but a very successful and high healing rate in a geriatric, polymorbid cohort.

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Outcomes After Operative Fixation of Vancouver B2 and B3 Type Periprosthetic Fractures

Cited by 12 publications

References 40 publications

The characteristics and predictors of mortality in periprosthetic fractures around the knee

The characteristics and predictors of mortality in periprosthetic fractures around the knee

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

Operative treatment of periprosthetic fractures of the proximal femur with a contralateral, upside-down LISS plate in elderly patients

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