Background: We analyzed the radiological and clinical results of our study subjects according to the management algorithm of the Vancouver classification system for the treatment of periprosthetic femoral fractures in hip arthroplasty. Methods: We retrospectively reviewed 18 hips with postoperative periprosthetic femoral fractures. The average follow-up was 49 months. The fracture type was determined based on the Vancouver classification system. The management algorithm of the Vancouver classification system was generally applied, but it was modified in some cases according to the surgeon's decision. At the final follow-up, we assessed the radiological results using Beals and Tower's criteria. The functional results were also evaluated by calculating the Harris hip scores. Results: Seventeen of 18 cases (94.4%) achieved primary union at an average of 25.5 weeks. The mean Harris hip score was 92. There was 1 case of nonunion, which was a type C fracture after cemented total hip arthroplasty, and this required a strut allograft. Subsidence was noted in 1 case, but the fracture was united despite the subsidence. There was no other complication. Conclusions: Although we somewhat veered out of the management algorithm of the Vancouver classification system, the customized treatment, with considering the stability of the femoral stem and the configuration of the fracture, showed favorable overall results.
