This 'Classifications in Brief' article describes the Vancouver classification of postoperative periprosthetic femur fractures, developed by Duncan and Masri. It explains the three-factor framework (location, implant stability, bone stock), maps each type to a treatment algorithm, and summarizes two independent validation studies confirming reliability and validity.
The B1/B2 distinction is the most consequential classification decision in periprosthetic fracture care. A loose stem fixed with plates instead of revised carries a nearly threefold mortality increase — not just a fixation failure, but a survival issue.
Plain radiographs frequently cannot resolve this question. When you see a Type B fracture with any uncertainty about stem stability, book the case with both a fixation set and revision femoral components on the table.
Intraoperative stress testing of the stem is the only definitive answer. The Vancouver classification explicitly acknowledges this: the preoperative type is a working diagnosis, not a final one.
The 11% one-year mortality of periprosthetic femur fractures (approaching that of native hip fracture at 16.5%) reframes how aggressively these patients need perioperative medical optimization. Treat them like hip fracture patients, not elective revision patients.
This 'Classifications in Brief' article describes the Vancouver classification of postoperative periprosthetic femur fractures, developed by Duncan and Masri. It explains the three-factor framework (location, implant stability, bone stock), maps each type to a treatment algorithm, and summarizes two independent validation studies confirming reliability and validity.
The B1/B2 distinction is the most consequential classification decision in periprosthetic fracture care. A loose stem fixed with plates instead of revised carries a nearly threefold mortality increase — not just a fixation failure, but a survival issue.
Plain radiographs frequently cannot resolve this question. When you see a Type B fracture with any uncertainty about stem stability, book the case with both a fixation set and revision femoral components on the table.
Intraoperative stress testing of the stem is the only definitive answer. The Vancouver classification explicitly acknowledges this: the preoperative type is a working diagnosis, not a final one.
The 11% one-year mortality of periprosthetic femur fractures (approaching that of native hip fracture at 16.5%) reframes how aggressively these patients need perioperative medical optimization. Treat them like hip fracture patients, not elective revision patients.