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Introduction: Management of periprosthetic femoral fractures is challenging. Vancouver classification is universally accepted for fracture description and management algorithm. Guidelines for the treatment of type B1 fracture is open reduction and internal fixation. The difficulty involved in managing this group is evidenced by the array of treatment options described in the literature., Methods: Thirty two patients with Vancouver type B1 fracture treated with osteosynthesis using cable plate (between 2007 and 2015) were reviewed retrospectively. There were 21 females and 11 males with an average age of 81yrs (56-96 years). The average follow-up was 21 months. All patients were reviewed clinically and radiologically until fracture united or patient re-operated. Postoperative protocol followed was six weeks toe touch weight bearing, 6 weeks partial weight bearing and then full weight bearing if there was no displacement. Post-operative radiographs were evaluated for fracture union. Statistical analysis was done using contingency tables with Fishers exact test and a p-value < 0.05 for significance., Results: In twenty four patients fracture union was achieved. Non-union was recorded in four patients. Comparing the different fracture patterns all non-unions occurred in the fractures which were short oblique or transverse at the cemented stem tip (p = 0.001). Fractures were more common in female patients and associated more with the uncemented femoral stems, but it was not associated with increased rate of non-union (p = 0.68). All failed osteosynthesis were revised successfully using long stem prosthesis. Two patients died within 2 months, one patient died within 4 months, one patient was lost to follow-up., Conclusion: Transverse or short oblique periprosthetic fractures around tip of cemented femoral stems can have high failure rates with just internal fixation. Revision arthroplasty may be the preferred option if possible otherwise may need to supplement fixation with cortical onlay graft. We should consider subcategorising Vancouver type B1 periprosthetic fractures into groups based on the pattern and fracture level in relation to the femoral stem., (Copyright © 2019. Published by Elsevier Ltd.)

Aim: To investigate demographics and outcomes of Vancouver type C periprosthetic femoral fractures (PPFF) treated with open reduction and internal fixation., Methods: Patient data were obtained from medical charts of cases reported to the Swedish Hip Arthroplasty Register and/or from the National Patient Register. Vancouver type C fractures undergoing surgery between 2001 and 2011, in patients who had received their primary THR between 1979 and 2011, were included. Any further reoperation performed between 2001 and 2013 and related to the PPFF constituted the primary outcome., Results: A total of 632 patients with 639 Vancouver type C fractures were identified. The majority of the patients were women (84%) and they had a fracture distal to a cemented stem (95%). The mean age at the time of fracture was 72 years. Treatment was performed with a locking plate (363 cases), a conventional plate (184 cases), an intramedullary nail (62 cases), or with double plating (30 cases). The overall reoperation rate was 17%, and mortality within one year of the operation was 16%. Locking plates had a significantly lower reoperation rate than conventional plates (p<0.001) and intramedullary nailing (p = 0.005). Interprosthetic femoral fractures did not have a statistically different outcome compared with non-IPFFs., Conclusions: The lowest reoperation rate was observed using locking plates in Vancouver type C fractures when compared with conventional plates or intramedullary nailing. The presence of an ipsilateral knee prosthesis did not influence the outcome of the surgical treatment., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Periprosthetic femoral fracture represent a severe complication, at present the third cause of revision surgery, with an estimated incidence from 0,1 to 2,1%. The number of these fracture can be expect to increase in line with the aging of population and amount of THA implants also in younger high demanding patients., Materials and Methods: The aim of this study is analyze the diagnostic and therapeutic decision making processes performed in 64 patients with periprosthetic fractures treated surgically from January 2012 and October 2016 in our center. We analysed instrumental exams and surgical reports focusing on type of procedure, surgical access, operative time and type of fixation., Results: Average age was 809 years and a mean follow-up 231 months. According to Vancouver system and after X-rays, CT scan and intraoperative evaluation, 26 fractures were classified as type B1, 31 as type B2, 3 type B3 and 4 type C. Follow up results were divided on the basis of the surgical treatment: in ORIF group (23 type B1 fractures and 4 type C fracture) fracture union was obtained in 16 cases (593%) and the final HHS mean value was 6161; in Revision group (3 type B1, 31 type B2 and 3 type B3) bone healing was reported in 26 cases (703%) with mean HHS score of 7194., Conclusions: In this surgery the objectives are provide an adequate bone healing and return to previous functional status as soon as possible. Many reasons make these goals challenging, in particular advanced age, osteoporosis, co-morbidity and weakness that lead to low energy trauma, the most frequent cause of these injuries. In our opinion a crucial aspect is the evaluation of stem stability, considering an implant mobilized until the opposite is clearly evident. Reduction of surgical time and early mobilization are goals of this surgery, often associated with several complications and high mortality rate., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Peri-prosthetic fractures (PPF) are a recognised complication following hip arthroplasty. Prosthesis design and type influence PPF pattern. Surgeons rely on classification systems, such as the Vancouver, to aid treatment planning. This study highlights a specific fracture pattern that occurs with cemented well-fixed polished, tapered, collarless (PTC) stems. We reviewed a consecutive series of 21 PPF around well fixed PTC stems. The majority of the fractures were classified pre-operatively as Vancouver B2 (14/21), but there were also B1 (6/21) and A type fractures. The B2 fractures had common radiological and intra-operative findings: a spiral fracture with extensive fragmentation of bone and cement, debonding of cement from the implant, cement fracture, and a well-fixed cement-bone interface. Reconstruction of these fractures was more difficult than suggested by the radiographs. Two of the six patients who were considered to have a Vancouver B1 fracture underwent open reduction and internal fixation (ORIF), and had treatment-related complications. Retrospective review of the radiographs showed subtle features, such as subsidence of the stem into the centraliser, that are characteristic of a B2 fracture pattern. In summary, it is important to recognise this fracture pattern around secure PTC stems in order to prevent misinterpretation of the fracture as a Vancouver B1 rather than a B2, leading to failure of treatment, and to alert the surgeon that complex reconstruction will be required because of the extensive fragmentation., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)