Question
An 80 year old woman falls and fractures her femur around a cemented total hip replacement inserted 10 years ago. The stem appears loose.
- How is this fracture classified?
- What determines treatment?
- What are your surgical options?
Answer
Classification (Vancouver)
| Type | Description |
|---|---|
| A | Trochanteric region, greater (AG) or lesser (AL) |
| B1 | Around the stem, stable stem |
| B2 | Around the stem, loose stem, good bone stock |
| B3 | Around the stem, loose stem, poor bone stock |
| C | Well below the stem |
What determines treatment
- Stability of the stem, judged on radiographs and confirmed at surgery
- Bone stock
- Fracture pattern and patient factors
- Infection must be excluded before revision
Surgical options
- B1, locking plate with cables and screws spanning the whole femur
- B2, revision to a long distally fixed stem bypassing the fracture by at least two cortical diameters
- Cemented stems with intact cement mantles can be treated with cement in cement revision in selected cases
- B3, revision with augmentation, allograft strut or proximal femoral replacement
- C, fixation as a standard femoral fracture with plate overlap of the stem
- Treat osteoporosis and involve orthogeriatric care
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.