title: A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures.
abstract: OBJECTIVE
  The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported.
  
  
  METHODS
  A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database.
  
  
  RESULTS
  A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation.
  
  
  CONCLUSIONS
  A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures. Cite this article:Bone Joint J2017;99-B(4 Supple B):17-25.
authors.affiliation: University of Nottingham, Nottingham NG7 2NR, UK.
authors.forename: T
authors.initials: T
authors.lastname: Khan
authors.affiliation: University of Nottingham, Nottingham NG7 2NR, UK.
authors.forename: D
authors.initials: D
authors.lastname: Grindlay
authors.affiliation: University of Nottingham, Nottingham NG7 2NR, UK.
authors.forename: B J
authors.initials: BJ
authors.lastname: Ollivere
authors.affiliation: University of Nottingham, Nottingham NG7 2NR, UK.
authors.forename: B E
authors.initials: BE
authors.lastname: Scammell
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: A R J
authors.initials: AR
authors.lastname: Manktelow
authors.affiliation: University of Nottingham, Nottingham NG7 2NR, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Pearson
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006622:Hip Prosthesis; D006801:Humans; D057068:Periprosthetic Fractures / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods
keywords: Periprosthetic fracture; Revision hip arthroplasty; Systematic review; Vancouver classification