Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern
Abstract Background Periprosthetic fractures are increasingly encountered in hip arthroplasty. The Vancouver classification system is widely used. Little knowledge exists regarding the association of the Vancouver classification with either cemented or uncemented stems. The aim was to analyse a seri...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-020-01619-4 |
| _version_ | 1811263417025036288 |
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| author | James Karam Paul Campbell Shivang Desai Michael Hunter |
| author_facet | James Karam Paul Campbell Shivang Desai Michael Hunter |
| author_sort | James Karam |
| collection | DOAJ |
| description | Abstract Background Periprosthetic fractures are increasingly encountered in hip arthroplasty. The Vancouver classification system is widely used. Little knowledge exists regarding the association of the Vancouver classification with either cemented or uncemented stems. The aim was to analyse a series of fractures and determine associations. Methods A series of consecutive patients over 8 years was identified including only post-operative fractures of primary hip arthroplasties. Baseline and radiographic characteristics were recorded including the type of stem fixation (cemented or uncemented) and Vancouver classification. Statistical analysis was performed to determine the association of the Vancouver classification between cemented and uncemented stems. Results A total of 172 patients were identified (84 cemented stems, 88 uncemented stems). There were 30 Vancouver A fractures (12 cemented vs.18 uncemented, p > 0.05), 125 Vancouver B fractures (63 cemented vs. 62 uncemented, p > 0.05) and 17 Vancouver C fractures (9 cemented vs. 8 uncemented, p > 0.05). The Vancouver B2 fracture occurred most frequently (N = 95; 44 cemented vs. 51 uncemented, p > 0.05) and consists of four distinct fracture patterns: the previously described comminuted ‘burst’, clamshell and spiral patterns and the newly observed ‘reverse’ clamshell. The burst and spiral fracture patterns are significantly associated with cemented stems, and the clamshell pattern is significantly associated with uncemented stems. Conclusions Vancouver A, B and C fractures occur equally in cemented and uncemented stems. Awareness of four distinct Vancouver B2 fracture patterns, including the newly observed reverse clamshell, will aid surgeons in predicting stem instability. |
| first_indexed | 2024-04-12T19:44:52Z |
| format | Article |
| id | doaj.art-00df62ef40cb437394de52796fc98da7 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-12T19:44:52Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-00df62ef40cb437394de52796fc98da72022-12-22T03:18:59ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2020-03-011511710.1186/s13018-020-01619-4Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture patternJames Karam0Paul Campbell1Shivang Desai2Michael Hunter3Gosford District Hospital, Central Coast Local Health DistrictGosford District Hospital, Central Coast Local Health DistrictGosford District Hospital, Central Coast Local Health DistrictGosford District Hospital, Central Coast Local Health DistrictAbstract Background Periprosthetic fractures are increasingly encountered in hip arthroplasty. The Vancouver classification system is widely used. Little knowledge exists regarding the association of the Vancouver classification with either cemented or uncemented stems. The aim was to analyse a series of fractures and determine associations. Methods A series of consecutive patients over 8 years was identified including only post-operative fractures of primary hip arthroplasties. Baseline and radiographic characteristics were recorded including the type of stem fixation (cemented or uncemented) and Vancouver classification. Statistical analysis was performed to determine the association of the Vancouver classification between cemented and uncemented stems. Results A total of 172 patients were identified (84 cemented stems, 88 uncemented stems). There were 30 Vancouver A fractures (12 cemented vs.18 uncemented, p > 0.05), 125 Vancouver B fractures (63 cemented vs. 62 uncemented, p > 0.05) and 17 Vancouver C fractures (9 cemented vs. 8 uncemented, p > 0.05). The Vancouver B2 fracture occurred most frequently (N = 95; 44 cemented vs. 51 uncemented, p > 0.05) and consists of four distinct fracture patterns: the previously described comminuted ‘burst’, clamshell and spiral patterns and the newly observed ‘reverse’ clamshell. The burst and spiral fracture patterns are significantly associated with cemented stems, and the clamshell pattern is significantly associated with uncemented stems. Conclusions Vancouver A, B and C fractures occur equally in cemented and uncemented stems. Awareness of four distinct Vancouver B2 fracture patterns, including the newly observed reverse clamshell, will aid surgeons in predicting stem instability.http://link.springer.com/article/10.1186/s13018-020-01619-4HipArthoplastyPeriprostheticFractureClassificationPattern |
| spellingShingle | James Karam Paul Campbell Shivang Desai Michael Hunter Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern Journal of Orthopaedic Surgery and Research Hip Arthoplasty Periprosthetic Fracture Classification Pattern |
| title | Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern |
| title_full | Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern |
| title_fullStr | Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern |
| title_full_unstemmed | Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern |
| title_short | Periprosthetic proximal femoral fractures in cemented and uncemented stems according to Vancouver classification: observation of a new fracture pattern |
| title_sort | periprosthetic proximal femoral fractures in cemented and uncemented stems according to vancouver classification observation of a new fracture pattern |
| topic | Hip Arthoplasty Periprosthetic Fracture Classification Pattern |
| url | http://link.springer.com/article/10.1186/s13018-020-01619-4 |
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