The Treatment Of Vancouver B Periprosthetic Femoral Fracture After Total Hip Arthroplasty

ObjectiveTo explore the treatment of Vancouver B intraoperative and postoperative periprosthetic fractures in total hip arthroplasty retrorespectively.MethodsAccording to the classification of Vancouver,33cases of periprosthetic fractures of the femur in total hip arthroplasty in recent years were analyzed. Treatment algorisms was based on the fracture classification and implant stability.There were11cases in type Bl,16cases in type B2,6cases in type B3. Open reduction and internal fixation with wires and allograft cortical strut bone or a longer stem cementless prosthesis revision were performed respectively. The patients were evaluated at regular intervals postoperatively using Harris Scores Scale.ResultsThrough average3.6years follow-up with range from0.5years to5.5years, all the patients were available for complete clinical and radiological analysis. The fractures were united, and satisfactory allograft incorporation to host bone was confirmed in4.5months. All33hips were functioning well. There was one case of refracture in group Bl and one case of prosthesis stem loosening3years after the surgery in group B2underwent revision surgery. In groupe B3, one patient was found deep infection within3months and the allograft was removed. Postoperatively, antibiotic therapy was administered for4to6weeks, followed by oral antibiotics for an additional6weeks. Laboratory tests, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used regularly for follow-up monitoring until normal results were achieved. There were no deep vein thrombosis and nerve injury in the patients.ConclusionVancouver classification in the periprosthetic fracture of the femur after total hip arthroplasty is a simple and practical method. Appropriate classification of periprosthetic femur fractures can direct subsequent management strategies. Open reduction and internal fixation with longer stem cementless prosthesis, onlay allograft cortical strut bone and fixed with wires for the treatment of periprosthetic fracture of the femur can achieved excellent results. The diagnosis and management of the periprosthetic fracture of the femur after total hip arthroplasty requires sophiscated understanding of classification and management options to guide appropriate treatment.