Figure 1. Anteroposterior radiograph of the left hip.
Figure 2. Anteroposterior radiograph of the left femur.
Figure 3. Lateral radiograph of the left hip.
An 88-year-old woman presents to the emergency department after a fall at home. Anteroposterior and lateral radiographs of the left hip and femur (Figures 1, 2, and 3) show a periprosthetic fracture around a prior left hip hemiarthroplasty.
According to the Vancouver classification system, which type of periprosthetic fracture does this patient have?
Submit your diagnosis to see full explanation.
The Vancouver classification system is the most widely used system to identify periprosthetic hip fracture type.1 The system classifies fractures by location, fracture pattern, and implant stability in order to guide treatment. The system includes types A, B, and C; type B is subdivided into types B1, B2, and B3. 1,2
A type A fracture occurs in the trochanteric region. Type A fractures with >2 cm of displacement should be treated with open reduction and internal fixation; fractures with <2 cm of displacement can be treated nonoperatively with partial weight bearing. Type B fractures occur around the stem. Type B1 fractures include those around the stem, or just below, with a well-fixed stem. Type B1 fractures are treated by open reduction and internal fixation with locking plates and cerclage wires. Type B2 fractures include a fracture around the stem with a loose prosthesis. Type B2 fractures are treated with a revision total hip replacement using a long stem. Type B3 fractures include those occurring around the stem with poor bone stock or severe fracture comminution. Type B3 fractures are treated with revision arthroplasty with bone graft or a proximal femoral replacement. Type C fractures are fractures that occur well below the prosthesis; these can be treated with open reduction and internal fixation without involving the prosthesis.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Gaski GE, Scully SP. In brief: classifications in brief: Vancouver classification of postoperative periprosthetic femur fractures. Clin Orthop Relat Res. 2011; 469(5):1507-1510.
- Karadsheh M. Periprosthetic fractures. Ortho Bullets. https://www.orthobullets.com/recon/5013/tha-periprosthetic-fracture. Accessed October 23, 2018.