Treatment of Periprosthetic Femoral Fractures in Hip Arthroplasty

Abstract

BackgroundWe analyzed the radiological and clinical results of our study subjects according to the management algorithm of the Vancouver classification system for the treatment of periprosthetic femoral fractures in hip arthroplasty.MethodsWe retrospectively reviewed 18 hips with postoperative periprosthetic femoral fractures. The average follow-up was 49 months. The fracture type was determined based on the Vancouver classification system. The management algorithm of the Vancouver classification system was generally applied, but it was modified in some cases according to the surgeon's decision. At the final follow-up, we assessed the radiological results using Beals and Tower's criteria. The functional results were also evaluated by calculating the Harris hip scores.ResultsSeventeen of 18 cases (94.4%) achieved primary union at an average of 25.5 weeks. The mean Harris hip score was 92. There was 1 case of nonunion, which was a type C fracture after cemented total hip arthroplasty, and this required a strut allograft. Subsidence was noted in 1 case, but the fracture was united despite the subsidence. There was no other complication.ConclusionsAlthough we somewhat veered out of the management algorithm of the Vancouver classification system, the customized treatment, with considering the stability of the femoral stem and the configuration of the fracture, showed favorable overall results.

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

“…In this study, which used ORIF to treat Vancouver type B2 PFF, rather than revision arthroplasty, minimized perioperative complications. Several authors have reported that fixation of PFF using plates is a reliable treatment option associated with a low rate of complications 13, 30, 31. Niikura et al treated select Vancouver type B2 patients with ORIF, achieved reliable outcomes, and suggested that decisions regarding the treatment of PFF should take into account not only the algorithmic approach of the Vancouver system but also on an assessment of each patient's physical status and activity level 12 .…”

“…Niikura et al treated select Vancouver type B2 patients with ORIF, achieved reliable outcomes, and suggested that decisions regarding the treatment of PFF should take into account not only the algorithmic approach of the Vancouver system but also on an assessment of each patient's physical status and activity level 12 . To successfully apply this strategy, the fracture location relative to the femoral prosthesis, implant stability, surrounding bone quality, and the patient's medical and functional status must be considered 5, 11, 31. One of the challenges for ORIF of PFF is to achieve sufficient fixation in the proximal fragment around the zone of the femoral prosthesis 32 .…”

Case report: diagnosi e trattamento di due successive fratture di femore su protesi d’anca

“…Per le fratture di tipo B2 sembra esserci accordo unanime sulla necessità di sostituzione protesica, ma Park e Macdonald [24,25] consigliano di aggiungere alla sostituzione anche la sintesi rinforzata con placca o trapianto corticale, anche se avvalorano le loro convinzioni con dati non statisticamente significativi a causa della bassa numerosità campionaria dei loro studi. Gli stessi Autori, inoltre, non considerano fondamentale l'utilizzo di allotrapianti ossei nel caso di fratture di tipo B3, avendo ottenuto stabilità e guarigione di queste fratture con la sola sostituzione dello stelo e fissazione con placca.…”

Revision hip arthroplasty as a treatment of Vancouver B3 periprosthetic femoral fractures without bone grafting

“…Time to full-weight bearing averaged 4 months postoperatively. At the final followup, radiographic results were evaluated using the Beals and Tower's criteria89 and functional outcomes were evaluated by the Merle d’Aubigné scoring system.…”