A Vancouver type B2 periprosthetic femoral fracture after total hip replacement is best managed by:

• A Open reduction and internal fixation with plate and cerclage wires
• B Revision hip arthroplasty with a long-stem femoral component bypassing the fracture ✓
• C Conservative management in a hip spica cast
• D Intramedullary nailing with supplementary cerclage wires

Explanation

Vancouver B2 fractures occur around a loose femoral stem; the stem fixation has failed, so simple ORIF will not address the unstable stem. Revision arthroplasty using a long-stem femoral component that bypasses the fracture by at least two cortical diameters (approximately 4–5 cm) is the standard of care. Vancouver B1 (stem well fixed) is treated with ORIF; Vancouver B3 (poor bone stock) may require impaction grafting or proximal femoral replacement.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.