Periprosthetic fractures of the proximal femur: beyond the Vancouver classification.

The majority of periprosthetic femoral fractures are treated surgically.Surgical treatment may be revision only, revision in combination with open reduction and internal fixation (ORIF), or ORIF only.The treatment decision is dependent on whether the stem is loose or not, but loose stems are not always identified, resulting in unsatisfactory treatments.This article presents an algorithmic approach to identifying loose stems around proximal femoral periprosthetic fractures, taking patient history, stem design, and plain radiographs into consideration. This approach may help identifying loose stems and increase the probability of effective treatments. Cite this article: EFORT Open Rev 2020;5:449-456. DOI: 10.1302/2058-5241.5.190086.