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Advances in Periprosthetic Fractures of the Hip Joint
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
Ali-Asgar Najefi, Arthur Galea, Nicholas Garlick, M. Zahid Saeed
The historical classification systems [44–47] for periprosthetic fractures of the femur have been superseded by the Vancouver classification system (VCS), which has become universally accepted [5, 48] (see Tables 4.1 and 4.2). The VCS describes the position of the femoral fracture relative to the prosthetic tip. Femoral component stability within the proximal fragment is the cornerstone of this classification.
Periprosthetic fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Adam Sassoon, George Haidukewych
Multiple classification schemes exist for periprosthetic fractures about a THA; however, the most widely used and accepted is the Vancouver classification system.9,10 This system focuses on fractures occurring around the femoral component and is particularly useful in that it guides treatment strategies. It divides fractures based on location, with Vancouver A fractures occurring at a trochanteric level, Vancouver B fractures occurring about the indwelling prosthesis (usually involving the tip of the stem) and Vancouver C stems occurring distal to the stem. There is further subclassification of Vancouver A fractures depending on whether the greater trochanter (AG) or lesser trochanter is involved (AL). Vancouver B fractures are also subclassified according to the stability of the indwelling femoral component and surrounding bone quality. Vancouver B1 fractures occur around a stable femoral component, while Vancouver B2 fractures have either directly resulted from component loosening or have occurred around an already loose component. Vancouver B3 fractures involve a loose component in the setting of poor bone stock (osteoporosis, extensive osteolysis, etc).
Femoral shaft, distal femoral and periprosthetic fractures
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
The Vancouver classification is the most widely accepted (Fig. 18.4). This is based primarily on the location of the fracture relative to the prosthesis, with subdivisions depending on stability, bone stock and precise location. Type A – above the tip of the prosthesis. AG – involving the greater trochanter.AL – in the region of the lesser trochanter.Type B – at or near the tip of the prosthesis. B1 – prosthesis stable.B2 – prosthesis unstable.B3 – prosthesis unstable with poor-quality osteoporotic bone.Type C – significantly below the tip and into the femoral diaphysis.
The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems
Published in Acta Orthopaedica, 2019
Georgios Chatziagorou, Hans Lindahl, Johan Kärrholm
Data for the primary THRs and the reoperations were derived from the SHAR. The reporting of primary hip arthroplasties is almost complete (98%) (Karrholm et al. 2017), whereas the reporting of reoperations is poorer (Söderman et al. 2000, Lindgren et al. 2014). Therefore, data linking was done between the SHAR and the National Patient Register (NPR), in order to detect even PPFFs not registered with the SHAR. Cross-matching for the other types of reoperations was not done. The NPR holds information on all inpatient care since 1987, and all outpatient care since 2001. Both private and public healthcare providers have had to report to the NPR since 2001. All medical records of reoperations due to fracture were collected and scrutinized to detect all femoral fractures in patients with a primary THR. The information provided in the case records was also used for fracture classification by GC, according to the Vancouver classification system (Brady et al. 1999). A detailed description of the classification process, as well as its validation, is described in a previous publication (Chatziagorou et al. 2018). Bilateral observations were included as previous studies have indicated that this will not cause significant problems related to dependency (Ranstam et al. 2011).
RE: De Meo D, Zucchi B, Castagna V, et al. Validity and reliability of the Unified Classification System applied to periprosthetic femur fractures: a comparison with the Vancouver system. Curr Med Res Opin. 2020. DOI:10.1080/03007995.2020.1776232
Published in Current Medical Research and Opinion, 2020
The Vancouver Classification System (VCS)6 for PPFF was once universally accepted. It focuses on the location of the fracture relative to the stem, the stability of the implant, and the associated bone loss. The VCS has been shown to be reliable and valid, but needs to be refined7–9. Lee et al.10 recently tested the reliability and validity of the VCS exclusively on type B fractures in cementless stems. The results also confirmed that radiographic assessment alone may be inadequate for the determination of stability of cementless stems in PPFF.
Validity and reliability of the Unified Classification System applied to periprosthetic femur fractures: a comparison with the Vancouver system
Published in Current Medical Research and Opinion, 2020
Daniele De Meo, Benedetta Zucchi, Valerio Castagna, Edoardo M. Pieracci, Massimiliano Mangone, Alessandro Calistri, Pietro Persiani, Ciro Villani
In Italy, periprosthetic fractures (PPF) are among the main causes of RTHA and account for 10.1% of them1. In the USA, revisions due to PPFs amount to 6.6%; the incidence of these fractures is expected to increase by 4.6% per decade6. Post-operative PFFs occur in a post-operative period equal to 7.4 years for THA and 3.9 years for RTHA7. The increase in use of non-cemented prostheses is probably an integral part of this complication’s increased frequency: in fact, the risk of developing a PPF with non-cemented prostheses is higher both intra-operatively and post-operatively years later (20-year probability of 7.7% in uncemented prostheses and 2.2% in cemented prostheses)8. Another factor that contributes to an increase in the incidence of PPFs is the increased life expectancy of patients who have had primary prosthetic implants in position for the past 20 years and have poor bone quality9. In fact, PPFs generally occur as a result of a spontaneous fracture or low-energy trauma10,11, while rarely due to high-energy trauma. The surgeon must have a clear vision of how to plan the revision surgery, or the osteosynthesis, in order to better manage this serious complication. The most used method for the evaluation of PPFs is the Vancouver Classification System (VCS) that, by dividing the femur into different anatomical zones based on the fracture level (Figure 1) and considering the presence or absence of a mobilisation of the components (Figures 2–5) and the quality of bone stock, can provide a practical and valid system for the management of these injuries12. Recently, another classification for PPFs has been put forth: the Unified Classification System (UCS). This system incorporates the VCS, though expanding it by including two further fracture subtypes – when applied to the femur – that are type D, a fracture that occurs between two prosthetic implants (hip and knee) (Figure 6), and type E, a fracture that occurs in both bones that support a prosthetic implant (acetabulum and femur) (Figure 7)13. The F type fracture, or acetabular fracture in case of hemiarthroplasty, can only be used when you take into consideration the UCS applied to the acetabular side. As with the VCS, the B subtypes are subdivided on the basis of implant stability and bone stock quality. An effective classification requires easy understanding, reproducibility, inclusiveness of all possible presentations of the injury and ability to target a well-defined treatment. If we consider the UCS as a logical evolution of the VCS, this increase in information and variables must not undermine its reproducibility and validity. Hence, the purpose of our study was to compare the interobserver and intraobserver agreement for the VCS and UCS, applied to the same cases of femur periprosthetic fracture, with the aim of highlighting any loss of reproducibility or validity.