A Vancouver Type B2 periprosthetic femoral fracture after total hip arthroplasty is best managed by:
- A Open reduction and internal fixation with locking plate alone
- B Intramedullary nail bypassing the femoral stem
- C Long stem revision femoral component with or without cerclage wiring ✓
- D Non-operative management with traction
Correct answer: C. Long stem revision femoral component with or without cerclage wiring
Explanation
Vancouver classification: Type A is trochanteric, Type B is around or just distal to the stem tip (B1 = stem well-fixed; B2 = stem loose; B3 = loose stem + poor bone stock), and Type C is distal to the stem. Type B2 involves a loose stem, so fracture fixation alone will fail — the loose implant must be revised to a longer, distally-fixed revision stem that bypasses the fracture site, often supplemented with cerclage wires or strut allografts. ORIF alone addresses the fracture but leaves the loose stem, predicting failure. An IMN cannot pass alongside a femoral stem.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.