Fractures and dislocations: Vancouver B2 periprosthetic fracture: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fractures and dislocations: Vancouver B2 periprosthetic fracture

Sample item

A 74-year-old woman falls 8 years after a cemented total hip replacement and fractures the femur at the level of the stem. Radiographs show the stem has subsided and is loose in its cement mantle, and the surrounding bone stock is good. What is the most appropriate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Revision arthroplasty with a long stem that bypasses the fracture

In the Vancouver classification, type B fractures lie around or just below the stem. B1 has a well-fixed stem and is fixed with a plate, whereas B2 has a loose stem with adequate bone and needs revision with a long stem. B3 has a loose stem with poor bone stock and needs complex reconstruction.

Option by option

  • A. Revision arthroplasty with a long stem that bypasses the fracture (correct)

    Correct. A loose stem with good bone (B2) is revised with a long stem that bypasses the fracture.

  • B. Removal of the prosthesis with a Girdlestone excision arthroplasty

    Girdlestone excision is a salvage procedure for infection or failed reconstruction, not for a loose stem with good bone.

  • C. Skeletal traction for 12 weeks without surgery

    Prolonged traction in an elderly patient risks pulmonary and skin complications and does not fix a loose implant.

  • D. Plate fixation with cerclage cables, retaining the loose stem

    Retaining a loose stem is the approach for B1 fractures, and fixation alone will fail because the stem keeps moving.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Revision arthroplasty with a long stem that bypasses the fracture. In the Vancouver classification, type B fractures lie around or just below the stem.

Why is "Removal of the prosthesis with a Girdlestone excision arthroplasty" not the answer?

Girdlestone excision is a salvage procedure for infection or failed reconstruction, not for a loose stem with good bone.

Why is "Skeletal traction for 12 weeks without surgery" not the answer?

Prolonged traction in an elderly patient risks pulmonary and skin complications and does not fix a loose implant.

Why is "Plate fixation with cerclage cables, retaining the loose stem" not the answer?

Retaining a loose stem is the approach for B1 fractures, and fixation alone will fail because the stem keeps moving.

What concept does this question test?

It tests Fractures and dislocations: Vancouver B2 periprosthetic fracture in Orthopaedics. B1 has a well-fixed stem and is fixed with a plate, whereas B2 has a loose stem with adequate bone and needs revision with a long stem. B3 has a loose stem with poor bone stock and needs complex reconstruction.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures and dislocations: Vancouver B2 periprosthetic fracture?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.