A 72-year-old man with a cemented total hip replacement 12 years ago presents with sudden onset hip pain after a minor fall. X-ray shows a fracture around the femoral stem. The stem appears well-fixed with intact cement mantle, fracture is at the proximal femur around the stem (zone B1). The best management is:
- A Non-operative management with traction for 6 weeks
- B ORIF with plate and cables/cerclage, preserving the well-fixed stem ✓
- C Component revision with long stem prosthesis bypassing fracture
- D Girdlestone excision arthroplasty
Correct answer: B. ORIF with plate and cables/cerclage, preserving the well-fixed stem
Explanation
Vancouver type B1 periprosthetic femoral fracture is defined by a fracture around or just below the stem tip with a well-fixed implant. Since the stem is stable, component revision is not required; ORIF with a plate (typically a locking plate) and cerclage cables achieves fracture fixation while preserving the well-fixed implant. Vancouver B2 (loose stem) requires revision with long-stem prosthesis; B3 (loose stem with poor bone stock) may require structural allograft. Non-operative management is inappropriate for displaced periprosthetic fractures.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.