~ 28 ~ National Journal of Clinical Orthopaedics 2018; 2(3): 28-32 ISSN (P): 2521-3466 ISSN (E): 2521-3474 © Clinical Orthopaedics www.orthoresearchjournal.com 2018; 2(3): 28-32 Received: 21-05-2018 Accepted: 24-06-2018 Sumit Kumar Junior Resident, Department of Orthopaedics, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India Mohit Dhingra MS Orthopaedics Associate Professor, Department of Orthopaedics, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India Pankaj Sharma Assistant Professor, Department of Orthopedics, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India Navneet Badoni MS Orthopaedics Professor, Department of Orthopaedics, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India Puneet Gupta Head of Department, Department of Orthopaedics, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India Mohd Bilal kaleem Junior Resident, Department of Orthopaedics, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India, Correspondence Mohit Dhingra MS Orthopaedics Associate Professor, Department of Orthopaedics, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India Management of periprosthetic femoral fracture after hip replacement (Vancouver b1): treating successfully using internal fixation Sumit Kumar, Mohit Dhingra, Pankaj Sharma, Navneet Badoni, Puneet Gupta and Mohd Bilal kaleem Abstract Periprosthetic femoral fractures associated with hip arthroplasty pose a significant challenge to the orthopedic surgeon and are difficult to treat. The incidence of periprosthetic fracture is increasing steadily due to increase in 1. Number of cases 2. Incidence of replacement surgeries Periprosthetic fractures after hip arthroplasty pose a significant challenge to the orthopedic surgeon as the treatment still remains controversial. The difficulty in treatment is due to 1. Age of the patient as most of the patients are of elderly age group. 2. Absence of bone stock 3. Presence of cement which hampers biological healing 4. Presence of implant which pose difficulty in putting another implant and fixing these fractures. Most common classification used for these fractures is Vancouver classification which takes into consideration the quality of bone, stability of implant and site of fracture and are challenging task for surgeon to treat, as the treatment remains controversial, difficult fracture fixation and bilological healing is compromied. Here we have included only Vancouver B 1 fractures in our study. These fracture are becoming important now a days because of increase number of replacemnt surgeries occuring world-wide. Keywords: Periprosthetic fractures, Vancouver classification, hip arthroplasty, internal fixation. Abbreviations: HHS, Harris Hip Score; THR, total hip replacement. Introduction Periprosthetic femoral fracture in association with total hip arthroplasty (THA) was first reported in 1954.1 since then, the incidence has steadily increased as the indications for THA have broadened and the life expectancy of the population has increased. 2-5 The current overall incidence of periprosthetic femur fracture is approximately 4.1%, with higher rates for uncemented and revision THA. 2 It defines the site of the fracture, the quality of the stem fixation, and the quality of the bone itself. When the fracture occurs around a well -fixed prosthesis (Vancouver type B1 fractures) osteosynthesis is recommended. 6 This is usually performed using osteosynthesis plating systems. In recent years, the preference has been for locking plates. 7 Classification The widely accepted classification system for postoperative periprosthetic fractures of the femur, developed by Duncan and Masri in 1995, which takes into consolidation at the location of the fracture, stability of the prosthesis, and quality of bone stock [12] . Commonly called the Vancouver classification, it has proved to be quite practical due to its reliability, high validity, and its established treatment algorithm [9-12] . Fractures are categorized by three types based on level. 1) Type A fractures are located at the proximal metaphysis, and are further subdivided based on involvement of the greater trochanter (AG) and lesser trochanter (AL).