|Beitragstitel||Is ORIF the better treatment for periprosthetic Vancouver type B2 femur fractures?|
There is some evidence, that stem retention with internal fixation might be a superior strategy, compared to stem exchange in periprosthetic Vancouver type B2 fractures. The goal of the here presented study was to investigate intra- and perioperative complications within these two alternate treatment concepts.
In a retrospective, single-center study 53 patients (36 female, 17 male), median age 79 years (range 51–93) who underwent surgery for periprosthetic Vancouver type B2 femur fracture between 01/2004 to 06/2016 were included. 26 patients (16 female, 10 male) median age 79.5 years (range 51–93) underwent stem revision (SR), while in 27 patients (20 female, 7 male) mean age 79 years (range, 56– 93) stem retention with internal fixation was performed. American Society of Anesthesiologists (ASA) classification, surgical time, intraoperative blood loss, required erythrocyte concentrates (EC), intra- and postoperative complications, length of hospital stay and need for further surgery were recorded.
ASA-classification and duration of hospital stay were not different in the two groups. Surgical time in the ORIF-group was 124.5 minutes (range, 75 – 194) vs. 150 minutes (range, 96 – 241) (p = 0.0187). Blood loss was 700 mL (range, 250 – 5200) in the SR-group compared to 500 mL (range, 50 – 1500) (p = 0.0422). Odds ratio to have a complication in the stem revision group (11 patients (46%) vs. 6 (22%); p = 0.1581) was 2.449 (95% CI: 0.7654 – 7.668). Odds ratio for revision surgery (4 patients (15%) vs. 3 (11%); p = 0.704) was 1.455 (95 % CI: 0.355 – 6.24). In one (4%) patient, ORIF failed and additional surgery was required. Odds ratio to die within first 12 months (5 patients (19%) vs. 1 (4%); p = 0.1003) was 6.19 (95% CI 0.6705 – 57.15) after stem revision.
Our results show significant lower surgical time, less blood loss, fewer required EC and a lower major complication rate in the ORIF group compared to the stem revision group. ORIF seems to be an alternate concept in the treatment of Vancouver type B2 fractures and our results suggest that elderly patients could benefit from this treatment method in terms of lower peri- and postoperative complication rate.