Abstract
The Exeter stem is a polished cemented stem that has been associated with an excellent survivorship. However, this wedge shaped stem has also been associated with a relative higher risk for a peri-periprosthetic fracture due to the wedge-shaped configuration that can lead to a Vancouver type B2 fracture when the stem is being driven downwards inside the femoral canal by a traumatic blast. Traditionally, these fractures should be treated with a revision stem because the stem has become loosened in the fractured cement mantle. We present a case series of 5 cases where our treatment algorithm was to first let the non-displaced fracture to consolidate by 6 weeks of limited weight bearing as tolerated in order to conduct a second stage in-cement revision. This would simplify the revision procedure dramatically. However, all patients are currently pain free and do not require revision surgery although they are being monitored very closely.
We conclude that non-displaced Vancouver type B2 fractures can be approached by a 2 stage treatment algorithm where the initial step is to let the fracture consolidate with limited weight bearing.
