Vancouver B Periprosthetic Femur Fracture Treatment: Subsidence or Dislocation, Pick Your Poison

Description

In this presentation by Ali Assaf, the focus is on the increasing issue of periprosthetic fractures, particularly discussing their management and implications in the medical field. Assaf highlights that periprosthetic fractures could soon be treated similarly to neck of femur fractures, emphasizing a choice between fixation and revision surgeries. He provides background on cemented taper slip stems, which are the preferred choice for over 80% of patients in the UK due to their high survivorship rate, but notes the associated risk of Vancouver B periprosthetic fractures.



Assaf reviews a study comparing fracture rates associated with different types of stems, revealing higher revision rates for certain designs. The crux of the presentation lies in a retrospective study conducted at Southampton Hospital that analyzed outcomes for patients with Vancouver B fractures. The study found that fixation procedures yielded fewer dislocations compared to revisions; however, fixation cases presented a higher rate of subsidence. Assaf summarizes the main findings, indicating that while fixation is advantageous in avoiding dislocations, it involves risks of subsidence that may lead to complications requiring further surgical intervention. Ultimately, he concludes that cemented revisions showed the lowest revision rate and were associated with the best outcomes, while recommending a balanced approach in treating such fractures.

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