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Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with
1Department of Orthopedics and Traumatology, Azienda Ospedaliero Universitaria Integrata of Verona, Piazzale A. Stefani n.1, 37126, Verona, Italy. spina.mauro@gmail.com.
Introduction:
The aim is to compare stem revision versus internal fixation with plate in the treatment of Vancouver B2 periprosthetic femoral fractures.
Materials And Methods:
This is a retrospective review of 34 consecutive patients admitted from June 1998 to May 2017. One patient was treated conservatively, 11 with stem revision (group 1), 20 with plate, screws and cerclage (group 2), one patient with cerclage alone and another by Girdlestone procedure. We assessed surgical complications, mortality within 1 year, functional outcome with Harris Hip Score and radiographic outcome with Beals and Tower's criteria.
Results:
At an average follow-up of 30.1 months in group 1, we had 36.4% of patients with complications, HHS of 66.8, radiographic outcome "excellent-good" in 91% of cases. In group 2 we had 25% of patients with complications, HHS of 71.8, radiographic outcome "excellent-good" in 80% of cases. There were no significant differences in 1-year mortality between the two groups. In group 2, the best outcomes were obtained in uncemented straight stems with Johansson type 1 fracture and in cemented polished stems with stem detachment from the cement-bone complex. Whatever treatment was adopted, there was an overall worsening in quality of life.
Conclusions:
Stem revision remains the treatment of choice in Vancouver B2 fractures, but, in selected cases, internal fixation with plate, screws and cerclage can be a viable alternative option.
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