Periprosthetic hip fractures: an update into their management and clinical outcomes

The Vancouver classification is still a useful tool of communication and stratification of periprosthetic fractures, but besides the three parameters it considers, clinicians should also assess additional factors. Combined advanced trauma and arthroplasty skills must be available in departments managing these complex injuries. Preoperative confirmation of the THA (total hip arthroplasty) stability is sometimes challenging. The most reliable method remains intraoperative assessment during surgical exploration of the hip joint. Certain B1 fractures will benefit from revision surgery, whilst some B2 fractures can be effectively managed with osteosynthesis, especially in frail patients. Less invasive osteosynthesis, balanced plate-bone constructs, composite implant solutions, together with an appropriate reduction of the limb axis, rotation and length are critical for a successful fixation and uneventful fracture healing.

Automated summary

The Vancouver classification is a useful tool for communicating and stratifying periprosthetic fractures, but clinicians should consider additional factors when assessing these injuries. Departments managing complex injuries should have combined advanced trauma and arthroplasty skills. Successful fixation and fracture healing require less invasive osteosynthesis, balanced plate-bone constructs, appropriate limb axis, rotation, and length, as well as intraoperative assessment.