During revision surgery for a periprosthetic femoral fracture, the stem is completely loose and the proximal femoral bone stock is severely comminuted and deficient, precluding secure fixation of any standard revision stem. The most appropriate reconstructive option is:

• A Open reduction and internal fixation with a locked plate and cerclage wires
• B Long uncemented diaphyseal engaging revision stem
• C Traction followed by delayed exchange nailing
• D Proximal femoral replacement with a tumour-type megaprosthesis or allograft prosthetic composite ✓

Explanation

Vancouver type B3 combines a loose stem with inadequate proximal bone stock, so neither plating nor a standard revision stem can achieve durable fixation. Reconstruction requires restoring the bone-deficient segment using a proximal femoral replacing megaprosthesis or an allograft prosthetic composite. A locked plate cannot stabilise a loose implant, and a diaphyseal stem needs sufficient intact tube to engage. Traction has no role in this unstable reconstruction problem.

Reference: Miller's Review of Orthopaedics, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.