Outcomes following non-operatively managed periprosthetic fractures surrounding uncemented femoral stems

Abstract

Background: The primary aim of this study was to explore the outcomes of Vancouver B periprosthetic hip fractures that were managed non-operatively with a particular focus on 1-year mortality. Understanding this mortality data will allow surgeons to better understand the risk associated with non-operative management. The secondary aim was to evaluate our case series and current literature with regards to identifying suitable patients for non-operative treatment.

Methods: Our electronic fracture database was interrogated for all Vancouver B periprosthetic fractures treated at our institution between April 2009 to April 2019; 18 patients were identified. All available data was then collected from radiographic, electronic and paper notes. A comprehensive literature search of PUBMED and EMBASE databases was then conducted with all relevant literature reviewed.

Results: 1-year mortality of these patients was noted at 22.2%; highlighting the severity of these injuries. No patients required conversion to surgical management, sustained a dislocation or went into non-union. With regards to literature no case series focussing on non-operative management outcomes were reported. There was a marked paucity of literature relating to conservative management of these injuries.

Conclusion: To our knowledge this is the first published case series focussing solely on nonoperatively managed Vancouver B periprosthetic hip fractures. This paper provides evidence from the first reported case series with which surgeons can counsel patients on the significant mortality risk associated with these fractures. Non-operative management of periprosthetic hip fractures is possible after careful analysis of the fracture configuration, implant and patient characteristics. Whilst we have outlined several findings from our first reported case series, further research is required from a larger prospective case series in order to make evidence based recommendations.

Keywords: Femur; Non-operative management; Peri-prosthetic fracture; Trauma.

Image. 1

88 year old patient, radiograph of peri-prosthetic femoral fracture taken at time of injury.

Image. 2

Radiograph taken 8.5months after Image 1 displaying successing radiological union.

Image. 3

84 year old patient,radiograph of peri-prosthetic femoral fracture taken at time of injury.

Image. 4

Radiograph taken 3months after Image 3 displaying successing radiological union.