Conservative Treatment for Minimally Displaced Type B Periprosthetic Femoral Fractures

Abstract

BACKGROUND: Surgical treatment has been invariably indicated for Vancouver type B periprosthetic femoral fractures (PFFs), which involve femoral diaphysis around stem. We evaluated the outcomes of nonoperative management in patients with minimally displaced type B PFFs around cementless stem. METHODS: From October 2009 to March 2016, 60 type B PFFs were treated at 1 institution. Among them, 19 minimally (<5 mm) displaced PFFs (31.7%, 19/60), which occurred around cementless stems, were treated nonsurgically with use of teriparatide. There were 6 men and 13 women. The mean age was 77.9 years (range, 51-98 years) at the time of PFF. The femoral stem was stable (type B1) in 11 patients and unstable (type B2) in 8. Teriparatide was injected from 1 to 4 months (mean, 3.2 months). We evaluated time to radiologic union and union rate. RESULTS: A successful union was obtained in 16 patients (89.5%, 17/19) at 2 to 6 months (mean, 3.5 months). The union rate was 100% (11/11) in type B1 fractures and 75% (6/8) in type B2 fractures. CONCLUSION: Our study showed that conservative treatment is feasible for the cases of type B1 minimally displaced periprosthetic fractures, and it may also be considered as an alternative option for type B2 minimally displaced periprosthetic fractures.