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Toe-touch weightbearing
0%
6/2197
Open reduction internal fixation with a cable plate
8%
182/2197
Revision of the femur with a long, cementless stem
83%
1829/2197
Revision of the femur with a long, cemented stem
165/2197
Girdlestone resection arthroplasty
5/2197
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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.
3.6
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