During revision total knee replacement, an intraoperative femoral fracture occurs at the level of the femoral stem tip. The distal fragment is well fixed to bone. Which Vancouver classification equivalent (using the Lewis & Rorabeck system for periprosthetic distal femur fractures) would this represent, and what is the preferred treatment?

• A Type I — non-displaced; conservative management
• B Type II — displaced with well-fixed implant; ORIF with locked plate
• C Type III — displaced with loose implant; revision arthroplasty with long-stem femoral component ✓
• D Type II — displaced with well-fixed implant; intramedullary nail

Explanation

Lewis & Rorabeck classification: Type I = undisplaced/non-displaced regardless of implant stability; Type II = displaced but implant well-fixed (ORIF); Type III = displaced with loose/failing implant requiring revision arthroplasty. A fracture at the stem tip with an already-failing revision construct typically implies implant loosening, placing it in Type III, mandating a longer-stem revision component. A nail cannot be passed with a well-fixed femoral implant in place.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.