A 68-year-old man with a cemented total hip replacement presents with a Vancouver B2 periprosthetic femoral fracture. The stem is noted to be well-fixed radiographically. The most appropriate management is:

• A Revision of the femoral stem to a cementless long-stem prosthesis
• B Conservative treatment with traction and protected weight-bearing
• C Intramedullary nailing bypassing the stem tip
• D Open reduction and internal fixation with plate and cerclage cables ✓

Explanation

The Vancouver classification guides periprosthetic femoral fracture management. Vancouver B2 indicates fracture at the stem level with a loose stem. However, the question states the stem is well-fixed, making this a Vancouver B1 fracture (fracture around the stem, stem well-fixed), which is best managed by ORIF with a locking plate and cerclage cables to achieve cortical union. B2 (loose stem) requires revision arthroplasty. Conservative management is reserved for stable, undisplaced trochanteric (A-type) fractures.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.