Open reduction and internal fixation in Vancouver Type B2 fractures - A retrospective single-center experience with a minimum follow-up of 6 months

Introduction Periprosthetic femoral fractures are an increasingly common complication following hip arthroplasty, particularly in elderly patients, and are associated with high mortality rates. Vancouver Type B2 fractures, involving a loose femoral stem with adequate bone stock, are traditionally managed with revision arthroplasty. However, in frail patients with high perioperative risk, open reduction and internal fixation (ORIF) represents a viable and less complex alternative due to reduced operative time, blood loss, and perioperative morbidity, while maintaining comparable clinical outcomes. This retrospective single-center study aims to evaluate the clinical and radiological outcomes of patients with Vancouver Type B2 periprosthetic femoral fractures (PPF) treated with ORIF without femoral stem revision over a ten-year period, with a minimum follow-up of six months. Materials and Methods This retrospective single-center study was conducted at an urban Level I trauma center. Between 2014 and 2023, patients with Vancouver Type B2 periprosthetic femoral fractures treated with open reduction and internal fixation (ORIF) without femoral stem revision and a minimum follow up of 6 months were included. Surgical fixation was performed via a lateral approach using 4.5 LCP Plates. Radiographic assessments included evaluation of stem subsidence, implant loosening, plate working length, and implant failure, based on imaging obtained postoperatively and at final follow-up. Results A total of 64 patients with Vancouver Type B2 fractures treated with ORIF were included. Anatomic fracture reduction was achieved in 81.3% of cases. Stem subsidence occurred in 60.9% of patients and was significantly associated with radiological signs of loosening. However, stem subsidence was not predictive of postoperative ambulation. Four patients (6.3%) required revision surgery. No correlation was found between postoperative weight-bearing protocol and achieved mobility. One-year survival was 66.2% on average. Conclusion ORIF appears to be a viable treatment option for selected patients with Vancouver Type B2 periprosthetic femoral fractures, particularly in elderly individuals with high surgical risk. Compared to data reported in literature, it offers shorter operative times, reduced transfusion requirements than revision surgery. It also indicates acceptable mid-term outcomes, with few complications requiring revision surgery.