Management of type B2 and B3 post-operative proximal periprosthetic femoral fractures, Oghara experience

Objective: To report the outcome of treatment of Types B2 and B3 Post- operative Periprosthetic proximal femoral fracture (PPFF) in four patients treated in Delta State University Teaching Hospital, Oghara, Delta State, using Vancouver classification of Duncan and Masri. Methodology: A retrospective study of four cases managed in this hospital. Information retrieved from case notes were sex, age, duration of prosthesis, treatment given, complications and outcome of treatment. Result: Atotal of 4 patients were reviewed in the study, 2 males and 2 females with a M: F of 1: 1. Duration of the implant before treatment was 5-12 years (mean of 8.3years). Age range was 60-83years (mean of 67.5 years). Two patients had Type B2 and two had Type B3. Average intraoperative blood loss was 1 litre. Duration of surgery was 3-4 hours. Duration of hospital stay was between 3 weeks and 5 months. The complications seen were primary haemorrhage, wound infection, hip dislocation and pulmonaryembolism. The outcome was good for 3 patients and fair in 1, using Harris Hip Score. Conclusion:Vancouver classification of Duncan and Masri is effective in the treatment of PPFF. Key words; Periprosthetic femoral fracture, Long stem hip prosthesis, Vancouver classification, osteolysis.

Periprosthetic hip fractures: an update into their management and clinical outcomes

The Vancouver classification is still a useful tool of communication and stratification of periprosthetic fractures, but besides the three parameters it considers, clinicians should also assess additional factors. Combined advanced trauma and arthroplasty skills must be available in departments managing these complex injuries. Preoperative confirmation of the THA (total hip arthroplasty) stability is sometimes challenging. The most reliable method remains intraoperative assessment during surgical exploration of the hip joint. Certain B1 fractures will benefit from revision surgery, whilst some B2 fractures can be effectively managed with osteosynthesis, especially in frail patients. Less invasive osteosynthesis, balanced plate–bone constructs, composite implant solutions, together with an appropriate reduction of the limb axis, rotation and length are critical for a successful fixation and uneventful fracture healing. Cite this article: EFORT Open Rev 2021;6:955-972. DOI: 10.1302/2058-5241.6.200050

Periprosthetic fractures of the proximal femur: beyond the Vancouver classification

The majority of periprosthetic femoral fractures are treated surgically. Surgical treatment may be revision only, revision in combination with open reduction and internal fixation (ORIF), or ORIF only. The treatment decision is dependent on whether the stem is loose or not, but loose stems are not always identified, resulting in unsatisfactory treatments. This article presents an algorithmic approach to identifying loose stems around proximal femoral periprosthetic fractures, taking patient history, stem design, and plain radiographs into consideration. This approach may help identifying loose stems and increase the probability of effective treatments. Cite this article: EFORT Open Rev 2020;5:449-456. DOI: 10.1302/2058-5241.5.190086