A 74-year-old man sustains a fall 9 years after total hip replacement. Radiographs show a comminuted subtrochanteric femoral fracture surrounding a loose cementless stem, with severe osteolysis and thinning of the entire proximal femoral cortex such that internal fixation is deemed impossible. According to the Vancouver classification, this fracture and its appropriate treatment are:
- A Type B3, treated by revision with proximal femoral reconstruction such as allograft-prosthetic composite or a modular fluted stem ✓
- B Type B2, treated by long-stem revision arthroplasty
- C Type B1, treated by open reduction and internal fixation
- D Type C, treated conservatively with protected weight bearing
Correct answer: A. Type B3, treated by revision with proximal femoral reconstruction such as allograft-prosthetic composite or a modular fluted stem
Explanation
Vancouver B3 denotes a periprosthetic femoral fracture around a loose stem with inadequate remaining bone stock, precluding simple stem exchange or fixation. Treatment requires reconstruction of bone stock, classically with an allograft-prosthetic composite, impaction grafting, or a modular fluted titanium stem that obtains diaphyseal fixation. B2 kills itself here because it implies sufficient proximal bone to support a long-stem revision alone.
Reference: Miller's Review of Orthopaedics, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.