Management of types B2 and B3 femoral periprosthetic fractures by a tapered, fluted, and distally fixed stem.

The management of periprosthetic femoral fractures is difficult and challenging. Nonsurgical and surgical treatment modalities have been described. We reviewed 24 patients (average age, 74 years) with types B2 and B3 fractures (Vancouver classification) managed with a cementless, tapered, fluted, and distally fixed stem using a transfemoral approach. Most fractures occurred after trivial trauma. This technique resulted in average operative periods of 3 hours 14 minutes with cup and stem revision and 2 hours 14 minutes with stem-only revision and in an average blood loss of 1700 and 940 mL, respectively. The average Harris hip score at follow-up was 69. Most fractures (91%) united uneventfully. The postoperative average radiological subsidence was 5 mm, occurring within the first 6 months before fracture union with no subsidence thereafter. Subsidence was absent in patients in whom the fracture failed to unite. There were 5 dislocations and 2 nonunions with 1 associated infection. The technique has proven to be reliable in the treatment of difficult fractures in this elderly population although concerns regarding the high dislocation rate remain.