Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain.
Injury. 2022 Mar;53(3):1218-1224. doi: 10.1016/j.injury.2021.10.026. Epub 2021 Oct 31.
There is currently a debate on whether all Vancouver type B2 (V-B2) periprosthetic hip fractures (PPHF) should be revised. Vancouver classification takes into account fracture location, implant stability and bone stock, but it does not distinguish between fracture patterns. The aim of our work was to study the different fracture patterns of V-B2 PPHF and to analyze if there is any pattern that presents lower osteosynthesis failure rates.
All patients with V-B2 PPHF treated by osteosynthesis between January 2009 and January 2019 were included in the study. Using the Gruen system the proximal femur was divided into 3 zones. The lateral zone (Gruen 1±2±3), medial zone (Gruen 5±6±7), and distal zone (Gruen 4±3±5) were analysed and it was determined whether each of the 3 zones was fractured.
56 patients were included in the study. Their mean age was 79 years (R 45 - 92). The chosen treatment was: 39 Open reduction and internal fixation (ORIF), 10 Stem revision and 7 nonoperatively treatment. In ORIF group, no implant complications (0/24) were found in patients with a single fractured zone, while 5 implant complications (5/15) were discovered in patients with two or more fractured areas; this difference was significant (p=0.0147). All patients treated by stem revision had a fracture that involved two or more zones. In the nonoperatively group, the fracture pattern did not influence the treatment because of all of them had a very precarious functional and medical situation.
V-B2 PPHF treated via ORIF affecting only one zone (medial, lateral, or distal) have a lower risk of complication than those affecting two or more zones. We propose a sub-classification of Vancouver B2 type fractures: B2.1 (1 fractured zone) and B2.2 (≥2 fractured zones).
Historical cohorts. Level III.
目前对于所有温哥华 B2 型 2 区（V-B2）髋关节假体周围骨折（PPHF）是否都应进行翻修存在争议。温哥华分类考虑了骨折部位、植入物稳定性和骨质情况，但没有区分骨折类型。我们的工作旨在研究 V-B2 PPHF 的不同骨折类型，并分析是否存在任何类型的骨折，其内固定失败率较低。
本研究纳入了 2009 年 1 月至 2019 年 1 月期间采用内固定治疗的 V-B2 PPHF 患者。使用 Gruen 系统将股骨近端分为 3 个区。外侧区（Gruen 1±2±3）、内侧区（Gruen 5±6±7）和远端区（Gruen 4±3±5）进行分析，并确定每个区是否发生骨折。
研究纳入了 56 例患者。他们的平均年龄为 79 岁（范围 45-92 岁）。选择的治疗方法为：39 例切开复位内固定（ORIF）、10 例髓内钉翻修和 7 例非手术治疗。在 ORIF 组中，在仅有单一骨折区的患者中未发现任何植入物并发症（0/24），而在有两个或更多骨折区的患者中发现了 5 例植入物并发症（5/15）；差异有统计学意义（p=0.0147）。所有接受髓内钉翻修治疗的患者均有两个或更多区域的骨折。在非手术治疗组中，由于所有患者的功能和医疗状况都非常不稳定，因此骨折类型并不影响治疗。
仅影响一个区（内侧、外侧或远端）的 V-B2 PPHF 经 ORIF 治疗的并发症风险低于影响两个或更多区的患者。我们提出了温哥华 B2 型骨折的亚分类：B2.1（1 个骨折区）和 B2.2（≥2 个骨折区）。
历史队列研究，III 级。
