Single-surgeon case series (n=7) describing a stepwise algorithmic approach to Vancouver B2 periprosthetic proximal femoral fractures — fractures around or just distal to a loose femoral stem. The paper asks whether a reproducible sequence of cerclage wiring, long-stem uncemented revision, and dual cortical allograft struts can reliably achieve fracture union and implant stability simultaneously.
When you encounter a Vancouver B2 fracture (loose stem, fracture at or just distal to the tip), use the fracture itself as your surgical window: cerclage the proximal tube first to restore canal geometry, revise to a long uncemented stem, then reinforce with two cortical strut allografts at 90° secured with cables — this sequence avoids the high nonunion rates of cement fixation and the new-fracture risk of plate-screw constructs while rebuilding bone stock long-term.
Single-surgeon case series (n=7) describing a stepwise algorithmic approach to Vancouver B2 periprosthetic proximal femoral fractures — fractures around or just distal to a loose femoral stem. The paper asks whether a reproducible sequence of cerclage wiring, long-stem uncemented revision, and dual cortical allograft struts can reliably achieve fracture union and implant stability simultaneously.
When you encounter a Vancouver B2 fracture (loose stem, fracture at or just distal to the tip), use the fracture itself as your surgical window: cerclage the proximal tube first to restore canal geometry, revise to a long uncemented stem, then reinforce with two cortical strut allografts at 90° secured with cables — this sequence avoids the high nonunion rates of cement fixation and the new-fracture risk of plate-screw constructs while rebuilding bone stock long-term.