8. Vancouver classification of intraoperative periprosthetic femur fractures around total hip arthroplasty

#### 8.1. Classifications

7. Dossick and Dorr classification of proximal femoral geometry

Based on the calcar-to-canal ratio which is defined as the diameter of the femur at the

Type A suitable for cementless femoral stem, type C requires use of cemented stem and type B

midportion of the lesser trochanter divided by the diameter at a point 10 cm distal [7].

7.1. Introduction

26 Total Hip Replacement - An Overview

7.2. Classification

Type A: Calcar-to-canal ratio < 0.5.

Type B: Calcar-to-canal ratio 0.5–0.75.

Type C: Calcar-to-canal ratio > 0.75.

7.3. Clinical significance

Figure 5. Dossick and Dorr classification.

is intermediate.

No thinning of cortices on AP or lateral radiographs.

Thinning of the posterior cortex on the lateral view.

Thinning of cortices on both views (Stovepipe femur) (Figure 5).

Type A: Proximal metaphyseal.

A1: Cortical perforation.

A2: Undisplaced linear crack.

A3: Displaced or unstable fractures.

Type B: Proximal diaphyseal.

B1: Cortical perforation.

B2: Undisplaced linear crack.

B3: Displaced or unstable fractures.

Type C: Distal diaphyseal fractures.

C1: Cortical perforation.

C2: Undisplaced linear crack.

C3: Displaced or unstable fracture [8].

#### 8.2. Clinical applications

Type A1: Bone graft alone.

Type A2: Circelage wire if using proximally porous coated stem and can be ignored if using fully porous coated stem and there is no distal extension into diaphysis.

Type A3: Needs fixation.

Type B1: Bypassing stem cortical allograft fixation.

Type B2: Circelage wire cortical allograft fixation.

Type B3: Long stem with cortical allograft fixation.

Type C1: Morselized bone graft bypass stem and cortical allograft.

Type C2: Circelage wire bypass stem and cortical allograft.

Type C3: ORIF (Figure 6).

9.2. Clinical application

B1: ORIF if displaced.

C: ORIF.

9.3. Reliability

(Figure 7).

B2: Revision to long stem.

B3: Revision with struct grafting.

Figure 7. Postoperative Vancouver classification.

This classification guides the surgeon with treatment decision.

AG and AL: Usually stable and can be treated non-operatively.

A European validation for this classification was performed by Rayan et al. The study had included consultants, trainees and medical students. It was noted to have an inter observer reliability of substantial agreement among consultants (k value of 0.72–0.74) orthopedic trainees (k value of 0.68–0.70) and medical students (k value of 0.61). The validity within B type fractures revealed an agreement of 77% with a k value of 0.67 [9, 10]

Classifications Used in Total Hip Arthroplasty http://dx.doi.org/10.5772/intechopen.77231 29

Figure 6. Intraoperative Vancouver classification.
