A 68-year-old man sustains a periprosthetic femoral fracture around a well-fixed uncemented total hip stem 3 years post-implantation. X-ray shows a spiral fracture at the level of the stem tip with distal cortex intact. This is classified as Vancouver type:

• A B2 — fracture around stem, stem loose
• B B3 — fracture around stem, poor bone stock
• C B1 — fracture around stem, stem well-fixed ✓
• D C — fracture distal to stem

Explanation

The Vancouver classification categorizes periprosthetic femoral fractures by location (A=trochanteric, B=around/at stem, C=distal to stem) and by stem fixation status. Type B1 is fracture around the stem with the stem well-fixed; B2 is around the stem with stem loose; B3 is around the stem with poor bone stock. In this case the stem is well-fixed (uncemented, 3 years, ingrowth assumed), so it is B1. B1 fractures can often be managed with ORIF (open reduction internal fixation) without stem revision, while B2/B3 require stem revision.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.