Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Review Question - QID 511

In scope icon L 1 A
QID 511 (Type "511" in App Search)
A 65-year-old healthy patient fell 18 years after a total hip arthroplasty and sustained the fracture shown in Figure A. Which of the following would be the most appropriate treatment?
  • A

Non weight bearing for 6-8 weeks



Open reduction internal fixation (ORIF) with cerclage cables



Revision to a long cemented femoral stem which bypasses the fracture



Revision to a fully porous coated uncemented femoral stem + ORIF



Revision to a proximal femoral replacement



  • A

Select Answer to see Preferred Response

bookmode logo Review TC In New Tab

This patient has a Vancouver B3 periprosthetic femur fracture which is most appropriately managed with a proximal femoral replacement (PFR).

The Vancouver classification of periprosthetic femur fractures is based on the fracture site, implant stability, and remaining bone stock. The patient in the question has a type B3 fracture. The cemented stem is loose and there is very poor remaining bone stock. He should be treated with a PFR due to the lack or proximal bone stock. Historically, proximal femoral allograft bone grafting was also an option but this has fallen out of favor due to better results with PFR and is only considered in younger patients with B3 fractures.

Klein et al. reviewed PFR for the treatment of B3 periprosthetic proximal femur fractures. They noted that with mean follow up of 3.2 years, all but one patient was able to walk with minimal to no pain. This said, they do report a relatively high complication rate including wound drainage, dislocation, re-fracture, and acetabular cage failure.

Rasouli et al. looked at the utilization of PFR and allograft composite prosthesis in the treatment of B3 periprosthetic femur fractures. They recommend allograft composite protheses in younger, more active patients in order to preserve any residual bone stock while they consider older and less active patients better candidates for PFR. Regardless of the procedure performed, complication rates are high for these patients and outcomes are not as good as for primary hip replacements.

Figure A demonstrates an AP radiograph showing a periprosthetic femur fracture with a loose stem and poor proximal femoral bone stock.

Incorrect Answers:
Answer 1: In a B3 periprosthetic femur fracture, nonoperative management with non weight bearing is not appropriate as the fracture will not heal in appropriate position and the patient is at risk for other medical problems during this time period.
Answer 2: ORIF is appropriate for B1 and C type fractures where the fracture occurs distal the stem (C) or around a well-fixed stem (B1).
Answers 3 & 4: Revision to a long, cemented stem is appropriate in rare circumstances with B2 fractures but a full porous coated uncemented stem is preferable. In this case of a B3 fracture, a PFR is the better choice.

Please Rate Question Quality


  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon


Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options