A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures

Aims The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported. Materials and Methods A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database. Results A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation. Conclusion A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures

Periprosthetic femoral fractures after total hip arthroplasty

BACKGROUND: The management of periprosthetic fracture following a total hip arthroplasty is difficult, requiring expertise in both trauma and revision surgery. With rising numbers of patients in the population living with hip prostheses in situ, the frequency of these fractures is increasing, and controversy remains over their ideal management. The objective of this study was to review all periprosthetic fractures at a single institution to identify injury and treatment patterns and their associated clinical outcomes. METHODS: Fifty-four periprosthetic fractures in 50 patients were reviewed to determine the relative frequency of fracture types, their complication rates and the clinical outcomes. Patient data were obtained through review of the clinical notes and individual patient follow up. Clinical outcomes were evaluated using the Oxford Hip Score and Harris Hip Score. RESULTS: The 54 fractures were classified using the Vancouver system, most of which were type B1 (20) or type B2 (10). The mean time to union for all fracture types was 4.6 months. A high non-union rate was seen among fractures fixed operatively. Fifteen per cent of fractures went on to develop loosening following treatment, suggesting an underrecognition at the time of injury. The average Harris Hip Score was 73.1 and Oxford Hip Score 30.3 for all fracture types at a mean follow up of 3.3 years. In the 15 patients treated with revision surgery, the most common complication was dislocation (27%). CONCLUSION: Treatment of patients with periprosthetic fractures requires recognition of the challenging nature of these injuries, the associated poor prognosis and the high complication rate.Simon W. Young, Salil Pandit, Jacob T. Munro and Rocco P. Pitt