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Vancouver A, Revision of femoral component to cemented stem with fixation of the fracture
1%
62/6708
Vancouver B1, Revision of femoral component to cemented stem with fixation of the fracture
2%
121/6708
Vanvouver B1, Revision of femoral component to a long, porous-coated, cementless stem with fixation of the fracture
8%
520/6708
Vancouver B2, Fixation of the fracture with a plate and cerclage wires
159/6708
Vancouver B2, Revision of femoral component to a long, porous-coated, cementless stem with fixation of the fracture
86%
5801/6708
Select Answer to see Preferred Response
Figure A shows a Vancouver B fracture around the femoral prosthesis. Because the prosthesis is noted to be loose during the operation, it is classified as a Vancouver B2 fracture. The most appropriate operation would be revision of the femoral component to a long, porous-coated, cementless stem in addition to fixation of fracture with a plate and cerclage wires. According to the Vancouver classification, a type B2 fracture occurs around or just distal to a loose femoral stem with adequate proximal bone. Revision of the femoral component is necessary, with uncemented stems showing superior clinical results to cemented stems in most studies. The revision prosthesis should bypass the distal fracture by 2 cortical widths. Corten et al. reviewed thirty-one patients with Vancouver B2 fractures that were treated with a long cemented stem with additional allograft or plate fixation. At 46 months, none of the implants had to be revised, but it should be noted that 43% of the patients died within the first year. Mulay et al. reviewed 24 patients with Vancouver B2 and B3 fractures managed with a cementless, tapered, fluted, and distally fixed stem. 91% of fractures united uneventfully. Complications included dislocations (5), non-unions (2), and infection (1). Springer et al. review 116 patients with Vanvouver B fractures treated with revision of the femoral component. The uncemented, extensively porous-coated implants had the highest likelihood of stable fixation and were not associated with any nonunions. Illustration A reviews the Vancouver classification for periprosthetic femur fractures. Illustration B shows a post-operative radiograph following a Vancouver B2 fracture. In this case, a trochanteric plate with cerclage wires was used to fix the fracture. A long-stemmed, porous-coated, cementless femoral prosthesis was used for the revision. Incorrect Answers: Answer 1: Vancouver A fractures involve the trochanteric region. Answer 2: Vancouver B1 fractures have a well-fixed femoral prosthesis. Answer 3: Vancouver B1 fractures have a well-fixed femoral prosthesis. Answer 4: Because the femoral prosthesis was loose, it needs to be revised.
4.5
(8)
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