Hip periprosthetic fracture typing and how to treat it

  Typology: Type A fractures are located at the proximal end of the prosthesis with a greater or lesser rotor fracture.  Type B fractures occur around or just below the stalk of the prosthesis Type B1 prosthesis is not loose and has no significant bone loss; Type B2 prosthesis is loose but has no significant bone loss; Type B3 prosthesis is loose and has significant bone loss.  Type C fractures occur at a site distant from the tip of the prosthesis.  Treatment: Most type A fractures can be treated with bed/braking and close observation. If the fracture is due to severe osteolysis, revision surgery should be performed, and if necessary, the acetabular prosthesis can be revised at the same time.  Type B fractures are common, and different subtypes have different fixation methods. Type B1 fractures with longitudinal splitting are fixed by 3-4 wire ties; spiral and oblique type B1 fractures are fixed by fracture incision and repositioning, with 3 allograft deep cryogenic frozen cortical bone plates placed on the anterior, medial and lateral femur, medial and lateral and autologous iliac bone cut into particles and implanted between the femur and the allograft bone plate, and fixed by wire ring ties.  In principle, type B2 fractures are revised using femoral lengthening stems, combined or uncombined with long allograft cortical bone reinforcement, and wire internal fixation with preserved prosthetic fracture incision and locking plate and autologous iliac bone graft is also feasible.  Type B3 fractures should be revised with a 200-mm long-stem cemented prosthetic stem and reinforced with allograft cortical bone plates.  Type C fractures require incision and internal fixation. If the prosthesis is loose, the fracture can be treated with incision and internal fixation first, and then revision can be performed after the fracture has healed.