924 Management of Vancouver B2 Periprosthetic Femoral Shaft Fractures

Abstract Aim An increase in hip arthroplasty surgery within our ageing population is leading to a rise in periprosthetic femoral shaft fractures. The Vancouver system is widely used to classify these fractures. Vancouver type B2 fractures are a subject of ongoing management debate, fixation versus revision arthroplasty. The aim of this study was to review the management and outcomes of all patients with a periprosthetic hip fracture over five years in a high-volume single centre with a particular focus on Vancouver B2 fractures. Method A retrospective analysis was conducted on patients admitted between September 2016 and September 2021 with periprosthetic femoral shaft fractures. Data on demographics, surgical management, and outcomes were gathered from electronic patient records. Outcomes were radiological union, mortality, and other complications. Results 168 patients were included in analysis, with an average age of 81. 54% of cases were Vancouver B2. 117 were managed with open reduction and internal fixation (ORIF), 51 with revision. 38% of patients died within the study period. Overall, 80% of revisions demonstrated radiological union, compared to 72% of ORIFs. 74% of Vancouver B2 revisions demonstrated radiological union, compared to 79% of ORIFs. 5.1% of patients died within the study period following revision, compared to 8.5% of those following ORIF. 4.3% of ORIFs went on to require revision surgery. Conclusions Periprosthetic fractures are challenging, especially B2 fractures often occurring in frail patients less fit for major surgery. This study has shown similar outcomes in revision and ORIF, suggesting B2 fractures can be effectively treated with ORIF.