The management of type B1 periprosthetic femoral fractures: when to fix and when to revise

Abstract

The incidence of periprosthetic fractures around total hip arthroplasty is increasing as patient longevity rises and the number of patients with hip implants continues to grow. Type B1 periprosthetic femoral fractures are associated with a well-fixed stem and have traditionally been treated with internal fixation. However, there are a subset of these fractures which fare badly when internal fixation is undertaken, and revision of the femoral component to a long-stemmed implant may be more appropriate. We look at the traditional methods of fixation, and the evidence and indications for revision of these fractures.

Management of periprosthetic femoral fractures following total hip arthroplasty: a review

“…In the majority of cases, surgical management is required. Vancouver B 1 fractures are reported to be at least one third of all the periprosthetic femoral fractures [20]. Historically, this type of fracture was treated non-operatively [21,22], or with skeletal traction [23].…”

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

“…Elastic xation (relative stability) with minimal soft-tissue damage seems to be preferred [24,40,57,58], relying on biological potentiality of the fracture, while a rigid xation (absolute stability) is advocate in some other cases [6,41,59]. Anyway, all Authors focused their attention over mechanical issues of the PFF [60,61], without taking into account patient's biological criteria.…”

Periprosthetic fractures and complicated arthroplasties

“…Märdian and colleagues discuss the outcomes after PPF around the hip [7]. Baba Tomonori from Japan discusses his own classification and its inter-observer variability [8] while Yassem and Haddad [9] as well as the next three papers coming from SouthKorea [10], Sweden [11] and France [12] discuss different aspects related to PPF in femur. The paper from Barut et al [13] provide insights of PPF around tumor prosthesis, as this situation adds to the complexity of the fractures associated to mega-or composite implants, a previous resection procedure, making internal fixation attractive but with high risk of revision.…”