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The pseudo A(LT) periprosthetic fracture: it's really a B2
Andrew P Van Houwelingen1, Clive P Duncan
1Department of Orthopedics, University of British Columbia, Diamond Health Centre, 3rd Floor, 2775 Laurel St, Vancouver, BC, Canada V5Z 1M9.
Orthopedics
|September 10, 2011
Summary
Periprosthetic fractures of the proximal femur involving the lesser trochanter are uncommon. Differentiating between avulsion fractures (Vancouver type A(LT)) and those with medial cortex involvement (new B2) is crucial for appropriate treatment and stem stability.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Biomedical Engineering
Background:
- Periprosthetic fractures of the proximal femur involving the lesser trochanter are rare.
- Vancouver type A(LT) fractures are avulsion injuries not affecting stem stability.
- A distinct 'new B2' fracture involves the proximal medial femoral cortex, potentially destabilizing the stem.
Purpose of the Study:
- To differentiate between Vancouver type A(LT) and 'new B2' periprosthetic fractures.
- To highlight the clinical significance of distinguishing these fracture types for treatment planning.
- To ensure satisfactory patient outcomes by guiding appropriate surgical or non-surgical interventions.
Main Methods:
- Review of clinical presentations and radiographic findings of lesser trochanter periprosthetic fractures.
- Analysis of fracture patterns, timing of occurrence, and associated implant characteristics.
- Correlation of fracture type with stem stability and treatment outcomes.
Main Results:
- Vancouver type A(LT) fractures are avulsion injuries and typically managed non-surgically.
- 'New B2' fractures, often occurring within 6 weeks post-operatively with cementless tapered stems, involve the medial cortex and risk stem destabilization.
- Intraoperative identification of nonpropagated cracks allows for revision with cerclage fixation; larger or postoperative fractures require stems fixed distal to the fracture.
Conclusions:
- Accurate differentiation between pseudo type A(LT) and type 'new B2' fractures is critical.
- Early recognition and appropriate management based on fracture characteristics and timing are essential for successful treatment.
- Distinguishing these fractures prevents unnecessary interventions and ensures optimal hip arthroplasty outcomes.
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