Abstract
Vancouver A: If minimal displacement and prosthesis stable can treat nonoperatively. If displacement is unacceptable and/or osteolysis is present consider surgery.
AL: Rare, avulsions from osteopenia and lysis. If large, displaced and include large portion of calcar-can destabilise stem and prompt femoral revision.
AG: More common. Often secondary to lysis. Does not usually affect implant stability. Minimal displacement. Treat closed × 3 months. Revise later is needed to remove the particle generator, debride defects and bone graft. Displaced with good host bone stock. Consider early ORIF and bone grafting.
Vancouver B:
B1: Rarely non-operative. ORIF with femoral component retention. Need to carefully identify stem fixation. B2's classified as B1's are doomed to fail. B1's correctly identified treated with plate, allograft struts or both. High union rates with component retention.
B2: Femoral revision +/− strut allograft. Best results seen with patients revised with uncemented, extensively porous coated femoral stems. May use modular, fluted taper stems.
B3: Proximal femoral replacement - Tumor prosthesis, Allograft Prosthetic Composite (APC). Uncemented femoral stem - Extensively porous coated, Fluted, tapered stem, Allograft strut.
Vancouver C: Treat with standard fracture techniques. These fractures are away from the femoral prosthesis. Rarely nonoperative. Fixation options – Cerclage, Strut Allograft, Plate fixation, Retrograde IM nail, or a Combination thereof. Avoid stress risers between implants. Bypass (overlap) fixation. Consider allowing 2.5 cortical diameters between devices.
