Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate.
INTRODUCTION
The aim is to compare stem revision versus internal fixation with plate in the treatment of Vancouver B2 periprosthetic femoral fractures.


MATERIALS AND METHODS
This is a retrospective review of 34 consecutive patients admitted from June 1998 to May 2017. One patient was treated conservatively, 11 with stem revision (group 1), 20 with plate, screws and cerclage (group 2), one patient with cerclage alone and another by Girdlestone procedure. We assessed surgical complications, mortality within 1 year, functional outcome with Harris Hip Score and radiographic outcome with Beals and Tower's criteria.


RESULTS
At an average follow-up of 30.1 months in group 1, we had 36.4% of patients with complications, HHS of 66.8, radiographic outcome "excellent-good" in 91% of cases. In group 2 we had 25% of patients with complications, HHS of 71.8, radiographic outcome "excellent-good" in 80% of cases. There were no significant differences in 1-year mortality between the two groups. In group 2, the best outcomes were obtained in uncemented straight stems with Johansson type 1 fracture and in cemented polished stems with stem detachment from the cement-bone complex. Whatever treatment was adopted, there was an overall worsening in quality of life.


CONCLUSIONS
Stem revision remains the treatment of choice in Vancouver B2 fractures, but, in selected cases, internal fixation with plate, screws and cerclage can be a viable alternative option.
['Spina|Mauro|M|http://orcid.org/0000-0003-0079-021X', 'Scalvi|Andrea|A|']
D000368:Aged D000369:Aged, 80 and over D019644:Arthroplasty, Replacement, Hip D001860:Bone Plates D005260:Female D005264:Femoral Fractures D005593:Fracture Fixation, Internal D006622:Hip Prosthesis D006801:Humans D008297:Male D008875:Middle Aged D057068:Periprosthetic Fractures D012086:Reoperation D012189:Retrospective Studies D016896:Treatment Outcome
Vancouver B2 Internal fixation Periprosthetic fracture Revision stem