Outcomes of Nonoperatively Treated Vancouver B1 Fractures : Is Failure Common?

Published by Elsevier Inc..

BACKGROUND: Periprosthetic fractures (PPFx) are a severe complication of total hip and hemiarthroplasty. Surgical treatment is typically performed but can result in major morbidity. Nonoperative PPFx management may provide a successful treatment alternative in select patients.

METHODS: Vancouver B1 PPFx patients treated over a 10-year period were identified. Patient demographic data were retrospectively recorded. Injury and postoperative radiographs were reviewed. There were 48 patients who met the study criteria. Patients were divided into operative and nonoperative comparative cohorts. Outcome comparisons between the 2 cohorts included 1-year mortality, unplanned surgery within 24 months of injury, fracture union rate, and return to preinjury ambulation status.

RESULTS: There was no difference in 1-year mortality between the nonoperative and operative cohorts (17 versus 8%; P = .32). We found no significant difference in unplanned surgery between the nonoperative and operative groups (8.7 versus 12%; P = .71), fracture union (100 versus 96%, P = .34), or return to ambulation status (86 versus 91%; P = .86). Nonoperative fractures were minimally displaced and within the metaphyseal region of the proximal femur without stem subsidence. Nonoperative fractures with subsequent treatment failure had initial fracture extension closer to the tip of the stem compared to successfully treated nonoperative fractures (5.5 versus 10.2 centimeters; P = .02).

CONCLUSION: Select nonoperatively treated patients had infrequent need for unplanned surgery, high union rate, and return to their preinjury ambulation status. Nonoperative management is not appropriate for all Vancouver B1 PPFx, but those patients who have minimally displaced meta-diaphyseal fractures and partial remaining distal fixation can be successfully treated.

Media Type:

Electronic Article

Year of Publication:

2023

Publication:

2023

Contained In:

To Main Record - volume:38

Contained In:

The Journal of arthroplasty - 38(2023), 7 Suppl 2 vom: 01. Juli, Seite S431-S437

Language:

English

Contributors:

Efird, William M [Author]
Boyd, Evan D [Author]
Schottel, Patrick C [Author]
Nelms, Nathaniel J [Author]
Blankstein, Michael [Author]

Links:

Volltext

Keywords:

Hip arthroplasty
Journal Article
Mortality
Nonoperative
Periprosthetic fracture
Vancouver B1

Notes:

Date Completed 25.07.2023

Date Revised 25.07.2023

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1016/j.arth.2023.03.069

funding:

Supporting institution / Project title:

PPN (Catalogue-ID):

NLM35506507X