Abstract
The most common classification of periprosthetic femoral fractures is the Vancouver classification. The classification has been validated by multiple centers. Fractures are distinguished by location, stability of the femoral component, and bone quality. Although postoperative and intraoperative fractures are classified using the same three regions, the treatment algorithm is slightly different.
Type A fractures involve the greater and lesser trochanter. Fractures around the stem or just distal to the stem are Type B and subcategorised depending on stem stability and bone quality. Type C fractures are well distal to the stem and are treated independent of the stem with standard fixation techniques. The majority of fractures are either B1 (stable stem) or B2 (unstable stem). The stem is retained and ORIF of the fracture performed for B1 fractures. B2 and B3 fractures require stem revision with primary stem fixation distal to the fracture.
Intraoperative fractures use the same A, B, C regions but are subtyped 1–3 as cortical perforations, nondisplaced, and displaced unstable fractures, respectively. With the exception of A1 intraoperative fractures all other intraoperative fractures require surgical treatment.
A recent publication utilizing a New York state registry highlighted the patient risk of mortality associated with periprosthetic hip fractures. One month, 6 month and 1 year mortality was 3.2%, 3.8% and 9.7%, respectively. The mortality risk was lower for periprosthetic fractures treated with ORIF at 1 and 6 months compared to fractures requiring revision total hip.
