Review Question - QID 4849

Figure B shows a Vancouver B2 periprosthetic femur fracture with an unstable femoral stem that requires revision arthroplasty with a long-stemmed prosthesis.

The Vancouver classification for periprosthetic femur fractures can help guide treatment of these challenging problems. Vancouver A fractures involve the greater and lesser trochanter and can be initially managed with non-operative measures. Vancouver B fractures occur around the stem and are broken down into B1 (stable prosthesis), B2 (unstable prosthesis) and B3 (poor proximal bone quality) fractures. B1 fractures may be treated with internal fixation, B2 fractures require a revision arthroplasty, and B3 fractures often require more advanced reconstruction with a proximal femoral replacement versus revision with a distally fixed prosthesis. Vancouver C fractures occur distal to the stem and require internal fixation.

Springer et al. reviewed 118 patients who underwent revision arthroplasty for Vancouver B2 periprosthetic fractures. They had a 90% survival rate at 5-years and a 79.2% survival rate at 10-years. The most common reasons for revision were loosening, infection, and non-union.

Illustration A shows the Vancouver classification of periprosthetic fractures about the femur.

Incorrect Answers:
Answer 1: Figure A shows an interprosthetic fracture with stable components best treated with internal fixation.
Answer 3: Figure C shows a Vancouver A fracture best treated with either non-operative management or internal fixation.
Answer 4: Figure D shows another interprosthetic fracture with stable components best treated with internal fixation.
Answer 5: Figure E shows a Vancouver B1 fracture with a stable component best treated with internal fixation.