Benjamin Schapira, Suroosh Madanipour, Padmanabhan Subramanian
{"title":"温哥华B2骨水泥抛光锥形滑动柄周围股骨假体周围骨折-我们应该如何治疗？一个系统的范围审查和管理算法。","authors":"Benjamin Schapira, Suroosh Madanipour, Padmanabhan Subramanian","doi":"10.1016/j.otsr.2024.104110","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Hypothesis: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>III; systematic scoping review.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104110"},"PeriodicalIF":2.3000,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Vancouver B2 Periprosthetic femoral fractures around cemented polished taper-slip stems - how should we treat these? A systematic scoping review and algorithm for management.\",\"authors\":\"Benjamin Schapira, Suroosh Madanipour, Padmanabhan Subramanian\",\"doi\":\"10.1016/j.otsr.2024.104110\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Hypothesis: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>III; systematic scoping review.</p>\",\"PeriodicalId\":54664,\"journal\":{\"name\":\"Orthopaedics & Traumatology-Surgery & Research\",\"volume\":\" \",\"pages\":\"104110\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-12-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Orthopaedics & Traumatology-Surgery & Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.otsr.2024.104110\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedics & Traumatology-Surgery & Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.otsr.2024.104110","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Vancouver B2 Periprosthetic femoral fractures around cemented polished taper-slip stems - how should we treat these? A systematic scoping review and algorithm for management.
Background: 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.
Hypothesis: 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.
Patients and methods: 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.
Results: 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.
Conclusions: 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.
Level of evidence: III; systematic scoping review.
期刊介绍：
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.
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