Francesco Roberto Evola, Gianfranco Longo, Maria Elena Cucuzza, Giuseppe Evola
Periprosthetic femoral fractures are a serious complication after total hip arthroplasty. The Vancouver classification divides fractures on location, implant stability and residual bone stock. The treatment of Vancouver B fractures is surgical and the first decision point surrounds whether or not the stem is well-fixed: well-fixed stems require Open Reduction and Internal Fixation, whereas loose stems require revision arthroplasty. Vancouver B1 fractures are treated with ORIF and had a poorer outcome when compared with B2 and B3 fractures because some B1 fractures were, in reality, probably B2 fractures. In Vancouver B2 and B3 fractures, the stem is loose and the revision of implant is mandatory. Controversy remains around the indications to perform ORIF or revision for Vancouver B fracture. In the future, it could be useful to combine information from both the radiographs and the medical records in order to be able to more correctly evaluate the type of fracture and its treatment.