Periprosthetic Fracture Management - Vancouver B2/B3 Hip
intermediate Level
Primary Indication
Periprosthetic femoral fracture around well-fixed (B1) or loose (B2/B3) stem
Danger Structures
Sciatic nerve - 15-30mm posterior to hip joint depending on approach and position, injury causes foot drop and sensory loss - EXAM KEY: identify and protect, keep hip flexed to relax nerve
Femoral neurovascular bundle - 30-50mm medial to anterior hip joint, injury catastrophic - EXAM KEY: stay on bone with anterior retractors
Superior gluteal neurovascular bundle - 30-50mm proximal to greater trochanter, injury causes abductor weakness - EXAM KEY: avoid proximal dissection, stay in safe zone
Lateral femoral cutaneous nerve - variable position 20-50mm from anterior incisions, injury causes meralgia paresthetica - EXAM KEY: protect when visible
Medial femoral circumflex artery - main blood supply to femoral head, at risk during capsulotomy - EXAM KEY: careful dissection around posterior femoral neck
Visual Atlas
No anatomy Images Yet
We're currently sourcing high-quality anatomy diagrams for this procedure.
Step-by-Step Technique
1
Assess stem stability - intraoperative evaluation essential: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
2
B1 (stable stem): ORIF with cables/plates: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Malposition of hardware
Damage to adjacent structures
3
B2 (loose stem, adequate bone): revision to longer stem: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
4
B3 (loose stem, poor bone): revision + augmentation/allograft: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
5
For B2/B3:: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
6
Extended trochanteric osteotomy or split lateral cortex: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
7
Remove loose stem and cement: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
8
Prepare canal with sequential reamers: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
9
Trial long stem bypassing fracture by 2 cortical diameters: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
10
Extensively porous coated or modular fluted stem: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
11
Reduce fracture around stem: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
12
Cerclage cables or plates for fracture stabilization: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Malposition of hardware
Damage to adjacent structures
13
Consider strut allograft for B3 with cortical deficiency: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
14
Impaction grafting option for younger patients: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
15
Perform intraoperative imaging/fluoroscopy to confirm adequate position and alignment
Surgeon's Tip
EXAM KEY: Documentation of intraoperative findings is crucial for Periprosthetic Fracture Management - Vancouver B2/B3 Hip.