Is Open Reduction Internal Fixation an Option for the Management of Vancouver B2 Periprosthetic Hip Fractures?

Abstract

Purpose: The increasing number of hip arthroplasties coupled with an ageing population has led to a growing burden of periprosthetic hip fractures. Fractures around the stem leading to loosening in the presence of good bone stock are classified as Vancouver B2. Operative management has traditionally been long stem revision arthroplasty. The aim of this study was to determine if open reduction and internal fixation (ORIF) is a safe and effective method of managing Vancouver B2 periprosthetic hip fractures in frail older patients.

Methods: A retrospective review was performed of all cases of periprosthetic hip fractures managed with ORIF at our institution. Data was collected on patient demographics, American Society of Anaesthesiologists (ASA) physical status classification, perioperative care, surgical management, and post-operative recovery. The primary outcome of our study was early revision surgeries. Secondary outcomes consisted of surgical time, complications, time to mobilisation, length of stay, time to fracture union, and Oxford Hip Scores.

Results: 15 patients were included, 4 men and 11 women, mean age 84 (SD 8.2). The ASA was III in 12 cases, II in 1 case, and IV in 2 cases. ORIF was performed by one of three fellowship-trained consultant hip surgeons using the DePuy Synthes VA LCP� Periprosthetic Proximal Femur Plating System. The mean follow-up duration was 10.1 months (SD 6.4 months).The mean operative time was 119 min (SD 31.4 min), the mean length of stay was 24 days (SD 23 days). There were no cases of inpatient mortality. There were 4 cases of wound infection. 2 patients died during the follow-up period. The mean time to mobilisation was 3.9 days (SD 3.1 days). There were no revisions or reoperations. The mean Oxford Hip Score at most recent follow-up was 30.5 (SD 8.3).

Conclusion: ORIF is a suitable alternative for the management of a Vancouver B2 periprosthetic fracture in frail older patients, in which good surgical outcomes can be achieved.