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Case Reports
. 2023 Mar 17:14:21514593221145884.
doi: 10.1177/21514593221145884. eCollection 2023.

Atypical Vancouver B1 Periprosthetic Fractures: The Unsolved Problem

Giovanni Vicenti  1 , Giuseppe Solarino  1 , Guglielmo Ottaviani  1 , Massimiliano Carrozzo  1 , Filippo Simone  1 , Giacomo Zavattini  1 , Domenico Zaccari  1 , Claudio Buono  1 , Davide Bizzoca  1 , Giuseppe Maccagnano  2 , Biagio Moretti  1
Affiliations
Case Reports

Atypical Vancouver B1 Periprosthetic Fractures: The Unsolved Problem

Giovanni Vicenti et al. Geriatr Orthop Surg Rehabil. .

Abstract

Atypical femoral fractures (AFF) are stress or insufficiency fractures induced by low energy trauma or no trauma, frequently correlated with prolonged bisphosphonate therapy. The diagnosis follows major and minor criteria, originally described by the Task Force of the American Society for Bone and Mineral Research in 2010 and updated in 2014. However, the definition of AFFs in the report excluded periprosthetic fractures. When atypical fractures occur close to a prosthetic implant the situation become critical, the surgical treatment is often demolitive and supported by medical treatment. Moreover, acute ORIF as a first line treatment is frequently burdened by a high failure rate , and often a stem revision is required as second line treatment. The healing process is long and difficult with poor functional results and impairing outcomes. We present a case treated at our institution of a 78 year old woman with a history of a femoral atypical periprosthetic fracture, complicated by multiple surgical revisions. Its arduous management reflects all the difficulties that these type of fractures could present to the surgeon, while its good final result may teach us how to approach them in a correct way.

Keywords: atypical femur fracture; femur fractures; open reduction and internal fixation; osteoporosis; periprosthetic fractures; revision stem; vancouver classification.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Transverse vancouver B1 periprosthetic fracture with cortical thickening.
Figure 2.
Figure 2.
Open reduction and internal fixation with NCB periprosthetic femur plate system (Zimmer Biomet, Warsaw), cerclages and medial cortical strut allograft.
Figure 3.
Figure 3.
Hardware failure 4 days after the surgery.
Figure 4.
Figure 4.
Reduction and fixation with a longer plate and a longer cortical strut on the medial side.
Figure 5.
Figure 5.
Refracture at the same level after 6 months of partial weight bearing.
Figure 6.
Figure 6.
Revision surgery with arcos modular femoral revision stem interlocking 20 mm × 250 mm (Zimmer Biomet, Warsaw) distally locked with 3 cortical screws.
See this image and copyright information in PMC

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