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Poster: 81The Treament of 83 Vancouver B2 and B3 Periprosthetic Fractures AroundLoose Femoral Implants: Methods and Outcomes*Jonathan Phillips - Queen's Medical Centre, Nottingham University Hospitals - Nottingham,UKChris Boulton - Queen's Medical Centre, Nottingham - Nottingham, UKChris Moran - Queen's Medical Centre, Nottingham - Nottingham, UKAndrew Manktelow - Queen's Medical Centre, Nottingham - Nottingham, UK*Email: jonphillips99@hotmail.comPeriprosthetic fractures around loose femoral implants represent a challenge to the surgeon. Wehave identified a cohort of 83 patients who have been admitted to the Queen’s Medical Centre,Nottingham since 1999 with Vancouver B2 or B3 periprosthetic fractures. Patients wereidentified via a prospective database of all trauma admissions and hospital notes wereindependently reviewed and data retrieved.We have examined the treatment methods and implants used, and identified their outcomes inrelation to union, further revision surgery and mortality.The mean age was 81 years and 55% were female. Fractures were classified as B2 (71%, n=59)and B3 (29% n=24). 65% occurred around a total hip replacement; 35% around a hiphemiarthroplasty after previous hip fracture. Periprosthetic fracture occurred around a Charnleystem (n=25), Austin Moore (n=20), Hastings (n=8), Exeter (n=7), other (n=10). 13 other patientshad undergone previous revision surgery.The mean time from index surgery to fracture around primary stems was 104 months (median85); revision surgery to fracture 74 months (median 72). Mean length of stay 37.5 days (range5-157).The stem was revised in 83% of cases (n=69: THR 44, Hemi 25). The acetabulum was revisedin 49% of cases. The choice of revision stem was a long uncemented modular stem in 51% ofcases (n=35: ZMR 24, Solution 9, Echelon 1), cemented stem in 26% of cases (n=18: Exeter13, Charnley 1, Thompson 1, Elite 5), long uncemented distally locked stem in 10% of cases(n=7: Reef 5, Huckstep 1, unknown 1), proximally and distally locked stem in 4% (n=3: Kent),proximal femoral replacement in 4% (n=3), and the original stem was reinserted in 3% (n=2).The fracture underwent fixation in 12% of cases (n=8 cases: THR 5, Hemi 3). 5 cases weredouble-plated. Fixation was chosen in 5 patients as they were considered too unwell to toleratemajor revision surgery. In two cases the stem was revised and the fracture was also plated. 5%of patients (n=4) were too unwell to undergo surgery.44 (53%) patients have subsequently died. Two others (2%) are lost to follow up and one isawaiting fracture union. Those alive have a mean follow up of 48 months (median 54).14 cases (17%) died before fracture union. One non-union occurred (deep infection prior toperiprosthetic fracture). 5 cases (6%) had deep infection at time of the periprosthetic fracture. Afurther two new deep infections occurred (3%). Dislocation occurred in 4 cases (5%).file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]