Internal fixation of selected Vancouver B2 periprosthetic femoral fractures: Can it be an alternative to the revision arthroplasty?

Abstract text (incl. references and figure legends)

Introduction:

The aims of this study were to evaluate outcomes of open reduction and internal fixation for the treatment of Vancouver B fractures and to analyze factors affecting prognosis of internal fixation in Vancouver B2 fractures.

Methods & Materials:

A retrospective analysis was performed on 36 of 52 patients whose follow-up periods were 6 months or more. The median follow-up period was 21.8 months (6-102 months). 14 cases were Vancouver B1, and 22 cases were Vancouver B2. The types of stems were 32 uncemented stems and 4 cemented stems (all polished). Cement breakages were observed in 3 of 4 cemented stems.

Results:

The average time to bone union was 18.5 weeks (7-36 weeks), and no significant difference was shown between the two groups(P=0.053): 14.5 weeks (7-25 weeks) in Vancouver B1 and 21.0 weeks (8-26 weeks). In Vancouver B2 fractures, the qualities of fracture reductions were good in 12 cases and poor in 10 cases. Femoral stem subsidence was observed in 6 cases, and all of which were from the cases with poor fracture reduction(P=0.003). 3 cases underwent revision surgery. Of 3 cases, 2 cases had femoral stem revision, and 1 case was treated with replacement of metal plate due to plate breakage at 2 months after the operation. Fracture reductions were poor in all revision cases, but no statistical differences were observed(P=0.078).

Conclusions:

As internal fixation with plate showed relatively satisfactory results in Vancouver B2 fractures, it can be a reliable alternative to revision arthroplasty. However, in order to avoid risk of reoperation and femoral stem subsidence, intraoperative accurate reduction is important, and special care must be taken when using cemented type, especially with cement breakage.

References:

Fracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review. https://doi.org/10.1007/s00402-020-03332-7

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