The Stability of Fixation of Vancouver B2 Periprosthetic Femoral Fractures: Effect of Implantation Technique

Authors

• Robert Frangie
• Shuyang Han
• Philip C Noble
• Jonathan E Gold
• Nicholas D Lanfermeijer
• Kartik I Reddy
• Sabir K Ismaily
• Jacob Su
• Steven J Schroder
• David Rodriguez-Quintana

Language

English

Publication Date

7-1-2023

Journal

The Journal of Arthroplasty

DOI

10.1016/j.arth.2023.03.008

PMID

36933680

Abstract

Background: Due to increasing volume of total hip arthroplasties, periprosthetic femoral fractures have become a common complication with increased revision burden and perioperative morbidity. The objective of this study was to evaluate the fixation stability of Vancouver B2 fractures treated with 2 techniques.

Methods: A common B2 fracture was created by reviewing 30 type B2 cases. The fracture was then reproduced in 7 pairs of cadaveric femora. The specimens were divided into 2 groups. In Group I ("reduce-first"), the fragments were reduced first, followed by implantation of a tapered fluted stem. In Group II ("ream-first"), the stem was implanted in the distal femur first, followed by fragment reduction and fixation. Each specimen was loaded in a multiaxial testing frame with 70% of peak load during walking. A motion capture system was used to track the motion of the stem and fragments.

Results: The average stem diameter in Group II was 16.1 ± 0.4 mm, versus 15.4 ± 0.5 mm in Group I. The fixation stability was not significantly different in the 2 groups. After the testing, the average stem subsidence was 0.36 ± 0.31 mm and 0.19 ± 0.14 mm (P = .17) and the average rotation was 1.67 ± 1.30° and 0.91 ± 1.11° (P = .16) in Groups I and II, respectively. Compared to the stem, there was less motion of the fragments and there was no difference between the 2 groups (P > .05).

Conclusions: When tapered fluted stems were used in combination with cerclage cables for treatment of Vancouver type B2 periprosthetic femoral fractures, both the "reduce-first" and "ream-first" techniques showed adequate stem and fracture stability.

Keywords

Humans, Hip Prosthesis, Reoperation, Treatment Outcome, Arthroplasty, Replacement, Hip, Periprosthetic Fractures, Femur, Femoral Fractures, Fracture Fixation, Internal, Retrospective Studies, Vancouver type B2 fracture, implant stability, interfragmentary motion, modular tapered fluted stem, periprosthetic femoral fractures, stem subsidence

Published Open-Access

yes

Recommended Citation

Frangie, Robert; Han, Shuyang; Noble, Philip C; et al., "The Stability of Fixation of Vancouver B2 Periprosthetic Femoral Fractures: Effect of Implantation Technique" (2023). Faculty, Staff and Student Publications. 3987.
https://digitalcommons.library.tmc.edu/uthmed_docs/3987