Management of late periprosthetic femur fractures: a retrospective cohort of 72 patients

Abstract

We present our series of 72 patients with periprosthetic fractures. The Vancouver classification was used to evaluate the fractures; there was one type A, seven type B1, 42 type B2, 17 type B3 and five type C fractures. Demographics, pre and postoperative data using Charnley-D'Aubigne-Postel score for assessment of function were recorded. The mean follow-up for all patients was two years. The overall outcome of treatment was graded as excellent, good or poor. An excellent result indicated that the arthroplasty was stable with minimal deformity and no shortening. Stable subsidence of the prosthesis or when the fracture healed with moderate deformity or shortening was deemed as a good result. A loose prosthesis, nonunion, sepsis, severe deformity or shortening was considered poor. In our series 79% (n = 57) had good or excellent results following surgical intervention and 21% (n = 15) had complications; they all had undergone re-operation for various reasons such as nonunion, loosening, dislocation or infection. In B2 fractures the stem is unstable and hence revision of the prosthetic stem has been recommended with or without additional fixation. For B3 fractures an allograft prosthesis composite or tumour prosthesis is considered the treatment choice.

Fig. 1

B3 periprosthetic femoral fracture

Fig. 2

Implant subsidence seen in B3 fracture treated with long stem revision

Fig. 3

B3 fracture treated with long stem revision

Fig. 4

Distal locking prosthesis with screw breakage