Archives of Orthopaedic and Trauma Surgery - 2026-04-17 - Journal Article
Managing Vancouver B2 periprosthetic femoral fractures: is open reduction and internal fixation superior to stem revision? : A comparative analysis with a minimum 5-year follow-up.
Wang T, Xu H, Wu J, Wang X
Topics
Key Takeaway
ORIF for Vancouver B2 periprosthetic femoral fractures achieved comparable HHS (73.56 vs 75.27) and radiographic success (91.3% vs 92%) to stem revision with significantly lower complication rates (21.7% vs 36%) at mean 63-month follow-up.
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Summary
This study compared stem revision (n=25) versus ORIF (n=23) for Vancouver B2 periprosthetic femoral fractures with minimum 5-year follow-up. ORIF demonstrated lower total complications (21.7% vs 36%), less blood loss, shorter operative time, and zero dislocations versus two in the SR group. Functional outcomes (HHS) and radiographic success by Beals and Tower criteria were statistically equivalent between groups, with one-zone fractures showing less subsidence than two-zone fractures (1.18 vs 1.87 mm).
Key Limitation
Non-randomized treatment allocation without defined selection criteria means the ORIF group likely harbored systematically lower-risk fracture patterns and healthier bone stock, confounding the complication and outcome comparisons.
Original Abstract
PURPOSE
The aim of this study was to compare the long-term outcomes of 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 (HHS), 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, while the fracture pattern was considerd, the one zone fracture demonstrated lower radiographic subsidence comparing with two zones fracture (1.18 ± 1.36 mm vs 1.87 ± 1.61 mm). Most of these patients in both groups did not return to their preoperative mobility status.
CONCLUSIONS
Although SR is the golden standard for Vancouver B2 periprosthetic fractures of the femur, ORIF can be a viable alternative for frail and low-demand patients on account of signifcantly less perioperative blood loss, shorter operating time and lower medical or total complication rates; expecially for the isolated medial or lateral zone fracture with primary long stem and “happy hips”.