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New periprosthetic hip fracture occurs early and can cause stem destabilization
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ORLANDO, Fla. — Periprosthetic hip fractures associated with loosening or poor bone stock, also known as Vancouver type-B3 fractures, are being seen more frequently, according to a Canadian orthopedic surgeon.
“The B3 [type] is rapidly rising and rapidly becoming more complex to fix,” Clive P. Duncan, MB, FRCSC, said at the 26th Annual Current Concepts in Joint Replacement Winter Meeting, here.
Type B1 and B2 fractures occur around or just below the stem. Type B3 are the most severe in the type B group with implant loosening that occurs in conjunction with poor bone stock.
In his presentation, Duncan discussed a newer approach for treating B3 fractures — reassembling the fractured area around a distally fixed scaffold.
New B2 type
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He also described a lesser trochanter-type fracture that resembles a type AL fracture, but is characterized by its early occurrence.
“It is really a new B2 [fracture],” Duncan said. However, it can be mistaken for an AL fracture because it involves the lesser trochanter, as well as the underlying medial femoral cortex, he explained.
This new B2 fracture usually occurs within 6 weeks of total hip arthroplasty (THA), Duncan noted. It is more common after minimally invasive THA with smaller incisions and in the femurs of elderly patients.
A technique to help prevent them intraoperatively involves placing a cerclage cable proximal to the lesser trochanter before broaching the canal.
- Reference:
Duncan CP. Peri-prosthetic fractures: Early & late. Paper #20. Presented at the 26th Annual Current Concepts in Joint Replacement Winter Meeting. Dec. 9-12, 2009. Orlando, Fla.
Clive P. Duncan, MB, FRCSC, is a consultant to Smith & Nephew.