Atypical Vancouver B1 Periprosthetic Fractures: The Unsolved Problem

Area of Science:

• Orthopedic surgery
• Bone healing
• Biomaterials

Background:

• Atypical femoral fractures (AFFs) are low-energy fractures linked to bisphosphonate use.
• Diagnostic criteria exist, but periprosthetic fractures were initially excluded.
• Periprosthetic AFFs present complex surgical challenges with high ORIF failure rates.

Observation:

• A 78-year-old woman experienced an atypical femoral periprosthetic fracture.
• The fracture was complicated by multiple previous surgical revisions.
• Management was arduous, reflecting the difficulties inherent in these cases.

Findings:

• Surgical treatment for periprosthetic AFFs is often demolitive.
• Acute ORIF as a first-line treatment has a high failure rate, often necessitating stem revision.
• The healing process is prolonged with poor functional outcomes.

Implications:

• This case underscores the difficulties in managing atypical femoral periprosthetic fractures.
• Successful management, even after multiple revisions, offers valuable insights.
• The presented case provides lessons for optimizing the surgical approach and improving patient outcomes.