A 71-year-old woman sustains a fall 3 years after uncemented total hip replacement. Radiographs show a spiral fracture of the femoral shaft around a well-fixed stem, extending past the tip of the prosthesis. According to the Vancouver classification, this is which type of periprosthetic femoral fracture?

• A Type B1 ✓
• B Type A(G)
• C Type B2
• D Type C

Explanation

Vancouver Type A fractures occur around or just distal to the stem. A1 denotes a well-fixed stem, managed with fixation such as plate and cables or strut grafts; A2 denotes a loose stem requiring revision; A3 combines a loose stem with poor bone stock. B well-fixed stem with fracture extending past the tip is therefore A1. Type C fractures are well distal to the stem and treated like ordinary shaft fractures.

Reference: Miller's Review of Orthopaedics, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.