Managing Vancouver B2 periprosthetic femoral fractures: is open reduction and internal fixation superior to stem revision?

The aim of this study was to compare the long-term outcomes of stem revision (SR) and open reduction and internal fixation (ORIF) for the treatment of Vancouver B2 periprosthetic fractures of the femur. From June 2013 to May 2023, 56 consecutive patients were studied at our institution. Four patients were lost to follow-up, four had incomplete data. Thus, 48 cases were included in the analysis. The patients were divided into a stem revision group (SR group with 25 patients) and an open reduction and internal fixation group (ORIF group with 23 patients). The surgical complications, perioperative parameters, and 1-year mortality rates were assessed, the functional outcomes were assessed with the Harris Hip Score (HHS), and the radiographic outcomes were assessed in accordance with the Beals and Tower criteria. In SR group, the mean follow-up time was 61.2 months, 36% of patients experienced complications, the mean HHS was 75.27, and 92% of the patients had “excellent–good” radiographic outcomes. In ORIF group, the mean follow-up time was 63.7 months, 21.7% of patients experienced complications, the mean HHS was 73.56, and 91.3% of the patients had “excellent–good” radiographic outcomes. The total number of postoperative complications, dislocation rate, blood loss volume, operation time and transfusion rate were lower in ORIF group, and two patients in SR group experienced hip dislocation. There were no significant differences in the 1-year mortality rate, bone healing time and reoperation rate between the two groups. However, while the fracture pattern was considerd, the one zone fracture demonstrated lower radiographic subsidence comparing with two zones fracture (1.18 ± 1.36 mm vs 1.87 ± 1.61 mm). Most of these patients in both groups did not return to their preoperative mobility status. Although SR is the golden standard for Vancouver B2 periprosthetic fractures of the femur, ORIF can be a viable alternative for frail and low-demand patients on account of signifcantly less perioperative blood loss, shorter operating time and lower medical or total complication rates; expecially for the isolated medial or lateral zone fracture with primary long stem and “happy hips”.