Radiologic outcomes of open reduction and internal fixation for cementless stems in Vancouver B2 periprosthetic fractures

Abstract

OBJECTIVE: The aim of this study was to evaluate the radiologic outcomes of open reduction and lateral plating with wiring in the treatment of Vancouver B2 periprosthetic femoral fractures. METHODS: We retrospectively recruited 37 patients treated with ORIF with lateral plating and wiring for Vancouver B2 fractures. The 27 patients (15 men and 12 women; mean age: 70.8±8.3 years) without follow-up loss had achieved complete bony union without notable complications. The average union period was checked after operation with radiologic findings. Radiologic outcomes were evaluated by ipsilateral limb length discrepancy (LLD) and subsidence between immediate postoperative length and length at postoperative 1 year after adjusting for magnification differences. The average distance to which the retained stem sunk down was investigated between immediate postoperative radiographs and final radiographs showing union. RESULTS: Ten patients could not be evaluated, because of mortality or failure to follow up. The average time to union was 18.3 weeks, and the average distance of stem sinking was 2.5±1.7mm (range: 0-7.2mm), which was significantly different between immediate postoperative radiographs and final radiographs. There was no case with loss of reduction or loss of fixation, requiring revision surgery. CONCLUSION: Open reduction and lateral plating with wiring as a treatment for Vancouver B2 periprosthetic femoral fractures produced good radiologic outcomes with successful bony union. ORIF can be considered the alternative option for treating patients with Vancouver B2 PPF, instead of stem revision surgery. LEVEL OF EVIDENCE: Level IV, Therapeutic study.