Schapira Benjamin, Madanipour Suroosh, Subramanian Padmanabhan
Trauma and Orthopaedics, Royal Free NHS Foundation Trust, Pond Street, London, NW3 2QG, United Kingdom.
Trauma and Orthopaedics, Royal Free NHS Foundation Trust, Pond Street, London, NW3 2QG, United Kingdom.
Orthop Traumatol Surg Res. 2024 Dec 13:104110. doi: 10.1016/j.otsr.2024.104110.
Periprosthetic femoral fractures (PFF) are a challenging complication of hip arthroplasty surgery, posing a high risk of morbidity, mortality and reoperation. The Vancouver Classification describes a B2 PFF around a loose stem with sufficient bone stock. In recent years, the number of B2 PFFs and cementation of femoral stems have increased substantially.
This systematic scoping review aimed to review the options available to surgeons in managing Vancouver B2 PFFs around cemented polished taper-slip (PTS) stems and establish an algorithm of management to treat varying fracture presentations.
This study reviewed articles reporting on Vancouver B2 PFFs around cemented femoral stems between 2012 and 2022. Data extracted included: patient demographics, index prosthesis, surgical intervention and decision for treatment, operation time, transfusion requirement, length of hospital stay, post-operative rehabilitation protocol, mobility outcomes, radiological outcomes, complications, reoperations, mortality rates and follow-up.
In total, fourteen studies met all inclusion criteria including 552 cases. Mean patient age was 76.8 years with a male:female ratio 1:1.83 and median follow-up 49.2 months. Treatment options included open reduction and internal fixation (ORIF), revision arthroplasty using cementless modular and monoblock long-stems ± distal locking, cement-in-cement revision and cemented long-stem revision ± impaction bone grafting.
Management of B2 PFFs around cemented PTS stems is complex and aims to obtain stable fracture and stem fixation. Options include ORIF, cement-in-cement and cementless revision. The optimal choice depends on a combination of patient, fracture and surgeon factors. This review has proposed an algorithm to aid in decision making.
III; systematic scoping review.
人工关节周围股骨骨折（PFF）是髋关节置换手术中具有挑战性的并发症，具有较高的发病、死亡及再次手术风险。温哥华分类描述了围绕松动假体柄且骨量充足的B2型PFF。近年来，B2型PFF的数量及股骨柄骨水泥固定的情况显著增加。
本系统综述旨在回顾外科医生处理骨水泥固定的抛光锥形滑移（PTS）柄周围温哥华B2型PFF的可用选项，并建立一种处理算法以治疗不同的骨折表现。
本研究回顾了2012年至2022年间报道骨水泥固定股骨柄周围温哥华B2型PFF的文章。提取的数据包括：患者人口统计学信息、初次假体、手术干预及治疗决策、手术时间、输血需求、住院时间、术后康复方案、活动结果、影像学结果、并发症、再次手术、死亡率及随访情况。
共有14项研究符合所有纳入标准，包括552例病例。患者平均年龄为76.8岁，男女比例为1:1.83，中位随访时间为49.2个月。治疗选项包括切开复位内固定（ORIF）、使用非骨水泥模块化和一体式长柄假体±远端锁定的翻修关节成形术、骨水泥套骨水泥翻修术以及骨水泥长柄翻修术±打压植骨术。
处理骨水泥固定的PTS柄周围的B2型PFF较为复杂，目标是实现骨折和假体柄的稳定固定。选项包括ORIF、骨水泥套骨水泥和非骨水泥翻修术。最佳选择取决于患者、骨折及外科医生因素的综合情况。本综述提出了一种有助于决策的算法。
III级；系统综述。
