During revision total hip arthroplasty, the surgeon encounters a Vancouver type B2 periprosthetic femoral fracture. The stem is loose and there is good bone stock. The most appropriate management is:

• A Open reduction and internal fixation with cortical strut allografts alone
• B Intramedullary nail through the existing prosthesis
• C Megaprosthesis proximal femoral replacement
• D Revision to a long-stemmed cementless femoral component bypassing the fracture ✓

Explanation

Vancouver type B2 fractures occur around a loose stem with adequate bone stock; the treatment of choice is revision arthroplasty using a long-stemmed cementless fluted tapered component that bypasses the fracture by at least two cortical diameters. ORIF alone without addressing the loose stem leads to failure. Megaprosthesis is reserved for Vancouver B3 (poor bone stock). Vancouver classification: B1 = stable stem, B2 = loose stem good bone, B3 = loose stem poor bone.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.