Reply

To the Editor,

Re: Uncemented extensive porous titanium-coated long femoral stem prostheses are effective in treatment of Vancouver type B2 periprosthetic femoral fractures: A retrospective mid- to long-term follow-up study. J Orthopaedic Surgery, published May–Aug 27(2). DOI: 10.1177/2309499019857653.

Diagnosis of Vancouver type B2 periprosthetic femoral fractures should be combined with preoperative radiographs and the actual situation during surgery

Dear Editor,

It is our pleasure to reply to the letter by Fan and Huang (DOI: 10.1177/2309499019857653). ¹ In our published manuscript, ² the fracture type in Figure 2 was actually the Vancouver type B2 fracture (Figure 1). According to the preoperative radiographs, the stem seems to be stable. Our preoperative diagnosis was also a Vancouver type B1 fracture. During the operation, we found that the stem was actually loose. Therefore, we corrected the diagnosis of a Vancouver type B2 fracture according to the Vancouver Classification System and chose the longer stem for revision. ³

Figure 1.

(a and b) Preoperative and (c and d) postoperative radiographs of a Vancouver type B2 periprosthetic femoral fracture that was treated with the Solution prosthesis combined with wire-ring fixation. (e and f) The radiographs at 98 months of follow-up.

For patients with periprosthetic femoral fractures, careful preoperative and intraoperative evaluation to determine whether the prosthesis is stable is very important. If necessary, surgeons need to reconfirm the stability of femoral prosthesis during surgery. If the fracture with a loose prosthesis is mistaken as a Vancouver type B1 fracture and treated only with open reduction and internal fixation, the result of treatment is certainly unsatisfactory. Further loosening of the prosthesis may occur after surgery, which may even affect fracture healing. ^{4 –6}

Vancouver classification is mainly determined by preoperative radiographs, but sometimes inaccurate judgment may occur. Corten et al. found that 20% of patients diagnosed with Vancouver type B1 fracture before surgery had prosthesis loosening during surgery. ⁷ Eventually the treatment had to be changed. Therefore, the stability of the prosthesis should be comprehensively judged by combining the preoperative radiographs and the actual situation during surgery, which is helpful to increase the diagnostic accuracy of Vancouver type B2 fracture.