Treatment of Periprosthetic Femoral Fracture according to the Vancouver Classification

Il-Yong Choi; Duk-Moon Jung; Seoung-Pyo Seo; Young-Ho Kim

doi:10.4055/jkoa.2007.42.2.147

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Choi, Jung, Seo, and Kim: Treatment of Periprosthetic Femoral Fracture according to the Vancouver Classification

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(2): 147-152.

Published online: 30 April 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.2.147

Treatment of Periprosthetic Femoral Fracture according to the Vancouver Classification

Il-Yong Choi, M.D., Duk-Moon Jung, M.D.^*, Seoung-Pyo Seo, M.D., Young-Ho Kim, M.D.

Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.

^*Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University, Seoul, Korea.

Address reprint requests to Young-Ho Kim, M.D. Department of Orthopaedic Surgery, Hanyang University, Guri Hospital, 249-1, Gyomun-dong, Guri 471-701, Korea. Tel: +82.31-560-2316, Fax: +82.31-557-8781, kimyh1@hanyang.ac.kr

Abstract

Purpose

To determine the treatment results according to the guideline of the Vancouver classification in periprosthetic femoral fractures.

Materials and Methods

Thirty-five periprosthetic femoral fractures treated between May 1981 and February 2003 were assessed. The mean age of the patients was 56 years (30-83 years). The outcomes were estimated according to the Beals and Tower's criteria.

Results

The overall incidence of postoperative periprosthetic femoral fracture was 0.91%. The frequency of the fracture types in decreasing order was B1, B2, B3, C, AG and AL. The treatment outcomes according to the Vancouver guidelines were excellent in 27 hips, good in 5 hips and poor in 3 hips. Suspicious risk factors of periprosthetic fractures were found in 6 hips (osteoporosis in 4 hips, osteolysis in 1 hip and loosening of femoral stem in 1 hip). Complications related to the treatment included a bony defect in 1 hip and an infection with non-union in 1 hip. The complications related to treatment for an implant were loosening in 2 hips and subsidence of stem in 1 hip.

Conclusion

In order to obtain favorable results, in addition to following the Vancouver treatment guideline, consideration should be made to the basic principles such as the stability of the fractures, the stability of the implant and restoration of the bone stock.

Keywords: Vancouver classification, Periprosthetic femoral fracture

Figures and Tables

Fig. 1

A 43-year-old male patient had a periprosthetic femoral fracture as a result of slip down. (A) The preoperative radiograph shows type B3 periprosthetic femoral fracture with severe proximal bone loss. (B) Postoperative radiograph at the second week shows that the fracture is reduced and fixed with a plate (supplementary fixation and additional allograft) but does not show a fully restored bone stock. (C) Postoperative radiograph at 26 months shows a varus shift the stem.

Fig. 2

A 32-year-old male patient had periprosthetic femoral fracture due to a traffic accident. (A) Preoperative radiograph shows type B3 periprosthetic femoral fracture. (B) Postoperative radiograph at the second week shows that fracture is stably fixed with a plate, screws and cerclage wire, and the remaining stem is stably fixed as well. (C) Postoperative radiograph at six months shows a healed femoral fracture and stable fixation of the stem.

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