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Orthopaedics
Periprosthetic Fractures
Built from Orthopedic Trauma Essentials
What’s inside
6 sections · 86 slides
Fractures around an implant
What these injuries are, why they are increasing, and the words used to describe them.
- A broken bone that already has metal in it
- Why we are seeing more of them
- Four things decide what you do
- A good classification does a job
- Hip replacement on a plain radiograph
- Knee replacement on a plain radiograph
- The short forms used throughout
- More short forms you will meet
- Two more terms worth defining now
Classifying the fracture
Vancouver and the Unified Classification System around the hip; Rorabeck-Taylor and Felix around the knee.
- What the hip systems are built on
- Vancouver: three places a hip fracture can sit
- Type B splits by stem and by bone
- What each type B subtype means for surgery
- Fracture around a hip stem before treatment
- From Vancouver to a system for every joint
- Unified Classification System (UCS) for the femur
- The letters Vancouver never had
- Where the two systems agree and differ
- UCS compared with the Vancouver classification
- Femoral shaft fracture below the tip of a hip stem
- How reliable are these labels in practice?
- Bone loss around a loose femoral stem
- Radiographs alone will not settle stability
- The decision sequence to run every time
- Reading the sequence
- Around the knee, different names, same logic
- What the two knee systems actually measure
- One table for all three regions
- Commonly used periprosthetic fracture classification systems and decision variables
- Decision pathway for a fracture around a hip stem
- Section summary: classification is stability-driven
Vancouver B2: fix it or revise it?
A loose stem with good bone. The classic answer is revision, but the evidence now supports a second pathway in selected patients.
- What a B2 fracture is
- The standard answer
- Why the question reopened
- Evidence: the 2022 systematic review
- Evidence: the 2021 JBJS Reviews analysis
- Evidence: the most recent synthesis
- Evidence: cemented polished taper-slip stems
- What all four studies are really saying
- The point is not abandoning revision
- Two pathways, chosen by the patient in front of you
- The same fracture after fixation with cables
- Use the table as a bedside checklist
- Practical decision points for ORIF versus revision in Vancouver B2 fractures
- Section summary: a dual-pathway approach
Distal femur fractures after knee replacement
Osteoporotic bone, a frail patient and a metal cap in the way. Plate, nail, augment or replace?
- Why these fractures are difficult
- Three questions decide fix versus replace
- Reading those three questions
- The four options on the table
- Evidence: comparing all three main strategies
- Evidence: plate versus nail for healing
- Evidence: replacement against fixation
- What 'medical complications' meant here
- Evidence: another look at DFR versus fixation
- KSS 80
- Reading those DFR numbers honestly
- Metal segment replacing the lower femur
- When one plate is not enough
- Match the method to the indication
- How to choose between plate and nail
- Take the table row by row
- Evidence signals across PDFF strategies after TKA
- Section summary: indication-based, not fashion-based
Fractures caught between two implants
Interprosthetic femoral fractures: a hip stem above, a knee stem below, and a short stretch of poor bone in between.
- A femur with metal at both ends
- Why this segment is so unforgiving
- Unpacking the mechanics
- The founding principles
- Evidence: what actually goes wrong
- If it does not heal
- Why recommendations are principle-based
- What those principles ask you to do
- When the bone is nearly gone
- Work the checklist before the incision
- Interprosthetic femoral fracture planning checklist
- Section summary: treat it as a two-implant problem
Pulling it together
The threads that run through every periprosthetic fracture decision.
- One question sits above all the others
- What the pooled evidence keeps repeating
- Five rules to carry into theatre
- Three settings, three default answers
- Where the evidence is still thin
- References
- References (continued)
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- Orthopedic Trauma Essentials 2026