How Should Vancouver B1-Periprosthetic Fractures at the Tip of a Cemented or Uncemented Femoral Stem Be Treated?

Response/Recommendation: The literature supports the notion that transverse or shortoblique B1-periprosthetic femoral fractures (PFFs) at the level or just below the tip of the stem (either cementless or cemented) have poorer results and suboptimal outcomes when treated with a single lateral plate osteosynthesis alone. This is due to increased strain at the fracture level, and thus, a higher risk of subsequent nonunion. We, therefore, recommend revision arthroplasty with a longer cementless distally-fixed stem, as this approach bypasses the fracture and enables both early weight-bearing and quicker healing. The decision between revision or fixation should take into account a patient's age, comorbidities, and stem integration. If fixation is chosen, single lateral plate fixation should be avoided; instead, fixation should be augmented with an additional orthogonal plate or a cortical strut allograft. Given the lack of high-quality studies, the true gold standard for the treatment of these fractures still needs to be defined.