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Review Question - QID 1010

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QID 1010 (Type "1010" in App Search)
An 82-year-old woman falls and sustains the fracture shown in figure A. She denies any history of dislocation or prodromal pain prior to her fall. What is the most appropriate treatment?
  • A

Toe-touch weightbearing

0%

6/2267

Open reduction internal fixation with a cable plate

8%

189/2267

Revision of the femur with a long, cementless stem

83%

1887/2267

Revision of the femur with a long, cemented stem

7%

170/2267

Girdlestone resection arthroplasty

0%

5/2267

  • A

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The radiograph demonstrates a periprosthetic femur fracture extending to the tip of the stem. The long spiral fracture is consistent with a loose implant. The bone stock is sufficient. Therefore, this fracture pattern would classify as a B2 using the Vancouver classification system. The Vancouver classification for periprosthetic femoral fractures is simple yet incorporates all the pertinent factors such a location, stem fixation, and bone stock. Type A is a trochanteric fracture- lesser or greater. These can be treated non-operatively usually and ORIF if symptomatic. Type B fractures are around or just below the stem and are subdivided into three types. Type B1 is a fracture with a well fixed stem. The treatment is cable plating or allograft struts or a combination of the two. Type B2 is a fracture with a loose stem with good bone stock. The treatment is a cementless porous coated long stem atleast two diameter length past the fracture site. Type B3 is a fracture with a loose stem and comminution. For younger patients, use cementless porous coated long stems with allograft struts. For older patients, consider a tumor prosthesis. Cement fixation is sometimes necessary Type C is a fracture well below the stem tip. These can be treated independently of the prosthesis.

Springer et al showed optimal outcomes with revision involving long extensively-coated femoral stems for Vancouver B fractures.

Masri et al review the classification and treatment of periprosthetic femur fractures.

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