A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures

Khan, T.; Grindlay, Douglas J.C.; Scammell, Brigitte E.; Ollivere, B.J.; Manktelow, A.R.J.; Pearson, Richard G.

Abstract

Aims The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported.

Materials and Methods A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database.

Results A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months.

Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation.

Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation.

Conclusion A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures.

Citation

Khan, T., Grindlay, D. J., Scammell, B. E., Ollivere, B., Manktelow, A., & Pearson, R. G. (2017). A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures. Bone and Joint Journal, 99-B(4_Supple_B), 17-25. https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-1311.R1

• Journal Article Type: Article
• Acceptance Date: Jan 9, 2017
• Online Publication Date: Mar 31, 2017
• Publication Date: Apr 1, 2017
• Deposit Date: Jan 12, 2018
• Publicly Available Date: Jan 12, 2018
• Journal: The Bone & Joint Journal
• Print ISSN: 2049-4394
• Electronic ISSN: 2049-4408
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 99-B
• Issue: 4_Supple_B
• Pages: 17-25
• DOI: https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-1311.R1
• Public URL: https://nottingham-repository.worktribe.com/output/970063
• Publisher URL: http://bjj.boneandjoint.org.uk/content/99-B/4_Supple_B/17