A periprosthetic femur fracture occurring at the tip of a cemented femoral stem with a well-fixed stem is classified as Vancouver type B1. The recommended management is:
- A Open reduction and internal fixation with a locking plate and cerclage wires, preserving the well-fixed stem ✓
- B Non-operative management in spica cast
- C Stem revision to a longer cementless revision stem bypassing the fracture
- D Above-knee amputation given the combined implant and fracture complexity
Explanation
Vancouver B1 periprosthetic femur fractures occur around or just distal to the stem tip with a well-fixed stem; the key distinguishing feature is that the prosthesis is stable. Since the stem is well-fixed and does not need revision, open reduction and internal fixation with a locking plate (e.g., LISS plate) supplemented by cerclage wires is the treatment of choice. Vancouver B2 (loose stem) requires stem revision, and B3 (loose stem with bone loss) needs revision stem plus augmentation or allograft. Non-operative management is not appropriate for displaced periprosthetic fractures.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.