Managing Vancouver B2 Periprosthetic Femoral Fractures in the Elderly: Is Open Reduction and Internal Fixation Superior to Stem Revision?

Purpose The aim of this study was to compare stem revision(SR) and open reduction and internal fixation(ORIF) for the treatment of Vancouver B2 periprosthetic fractures of the femur. Methods 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, and the radiographic outcomes were assessed in accordance with the Beals and Tower criteria. Results 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, the time to total weight-bearing in the SR group was shorter than that in the ORIF group, and the radiographic subsidence rate in the SR group was lower than that in the ORIF group, especially for patients with poor compliance. Most of these patients in both groups did not return to their preoperative mobility status. Conclusions Although SR is the gold standard for Vancouver B2 fracture treatment. ORIF can be a viable alternative for elderly patients on account of signifcantly less perioperative blood loss and a shorter operating time, But showed disadvantages in terms of earlier weight-bearing and the radiographic subsidence rate.