title: Outcome after operative treatment of Vancouver type B1 and C periprosthetic femoral fractures: open reduction and internal fixation versus revision arthroplasty.
abstract: BACKGROUND
  The rate of periprosthetic femoral fractures after hip arthroplasty is rising and the estimated current lifetime incidence is 0.4-2.1%. While most authors recommend revision arthroplasty in patients with loose femoral shaft components, treatment options for patients with stable stem are not fully elucidated.
  
  
  METHODS
  Against this background we performed a retrospective chart analysis with clinical follow-up examination of 32 cases that sustained a Vancouver type B1 or C periprosthetic fracture (stable stem).
  
  
  METHODS
  Overall 16 cases were treated by open reduction and internal fixation (ORIF) by plate osteosynthesis and 16 cases by revision arthroplasty (RA). Both groups were comparable regarding age, gender, follow-up time interval, time interval from primary hip arthroplasty to fracture and rate of cemented femoral components, but more type C fractures were treated by ORIF.
  
  
  RESULTS
  Functional outcome expressed by the median timed "Up and Go" test did not differ significantly (30 s ORIF vs. 24 s RA, P = 0.19). However, by comparable systemic complications surgery-related complications were significantly more frequent in plate osteosynthesis (ORIF n = 10 vs. RA n = 3, P = 0.03). Based on our results, further studies, preferable via a multicenter approach, should focus on identifying patients that benefit from ORIF in periprosthetic fractures. A misinterpretation of type B2 fractures with loose implant as type B1 fractures may cause implant failure in case of ORIF.
  
  
  CONCLUSIONS
  The use of angular stable implants, additional cable wires or bone enhancing means is recommended.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, J.W. Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Helmut L
authors.initials: HL
authors.lastname: Laurer
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wutzler
authors.forename: Susann
authors.initials: S
authors.lastname: Possner
authors.forename: Emanuel V
authors.initials: EV
authors.lastname: Geiger
authors.forename: André
authors.initials: A
authors.lastname: El Saman
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
authors.forename: Johannes
authors.initials: J
authors.lastname: Frank
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001858:Bone Nails; D001860:Bone Plates; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome