Open reduction and internal fixation might be a valuable alternative to stem revision in Vancouver B2 periprosthetic femoral fractures, irrespective of the stem’s design

• Published in: Archives of orthopaedic and trauma surgery 2021-05, Vol.141 (5), p.871-878
• Main Authors: Flury, Andreas, Hasler, Julian, Pagenstert, Geert, Dimitriou, Dimitris, Helmy, Naeder, Finsterwald, Michael
• Format: Article
• Language: English
• Subjects: Body mass index; Bone surgery; Comorbidity; Fractures; Joint surgery; Medical personnel; Medicine; Medicine & Public Health; Morphology; Mortality; Orthopedics; Prostheses; Surgical techniques; Transplants & implants; Trauma; Trauma Surgery; X-rays
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-020-03568-3

Background The purpose of this study was to compare the clinical and radiological outcomes following open reduction and internal fixation (ORIF) of Vancouver B2 periprosthetic femoral fractures versus stem revision (SR) surgery. Methods Between 2004 and 2018, 39 patients were treated with SR and 31 with ORIF for a Vancouver type B2. Mean follow-up was 40.4 months for the ORIF group and 43.5 months for the SR group. 22 of 31 stems in the ORIF group were uncemented, of which 7 (23%) were short stems. Perioperative complications, intraoperative blood loss, revision rate, and mortality were recorded. Functional outcomes included Harris Hip Score, Parker Mobility Score and hip abductor strength. Results Both groups did not differ in the American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, body mass index, age, and sex. Compared to SR, patients treated with ORIF had a decreased blood loss, transfusion rate, operation duration, and mortality. Total complication and re-operation rates were similar. The relative risk for complication and re-operation was 0.5 and 0.7, respectively, in favour of ORIF. Conclusions ORIF might be a valuable alternative to SR in the treatment of Vancouver type B2 periprosthetic fractures with shorter operation duration, lower blood loss and similar complication rate compared to SR. Moreover, re-stabilization seems possible irrespective of stem’s design or fixation technique. Level of evidence Level III