Periprosthetic Femoral Fractures in the Emergency Department: What the Orthopedic Surgeon Wants to Know

Abstract

This article discusses the criteria for the Vancouver classification of periprosthetic fractures and reviews total hip arthroplasty images, the most common periprosthetic fracture patterns, and multiple case examples to emphasize how imaging findings affect management decisions made by orthopedic surgeons. Femoral fracture in the setting of a hip arthroplasty is an increasingly common complication encountered in the emergency department (ED). Diagnosis and management of periprosthetic fractures are complicated, and orthopedic surgeons rely on imaging findings to guide the appropriate management approach to the injury. Delay in identification and appropriate definitive management of periprosthetic fractures is associated with high morbidity and mortality. At present, the Vancouver classification system for periprosthetic hip fractures is the most common classification system used by orthopedic surgeons. It relies on three radiographic criteria—fracture location, prosthesis stability, and quality of the femoral bone stock—to characterize these fractures and to help guide management decisions. Familiarly with the Vancouver classification system allows radiologists to both recognize and communicate the most clinically relevant imaging findings to the treating orthopedic surgeon. This article reviews the imaging...