Abstract
We herein report a case involving three failures of internal fixation after periprosthetic femoral fracture (Vancouver type B1). The patient had low bone mass (T-score of -1.7) and was overweight (body mass index of 28.7 kg/m(2)) but had no sign of femoral stem loosening. The first open reduction with internal fixation was performed according to the recommended treatment. Unexpectedly, three treatment failures subsequently occurred, after which the patient finally attained endurable walking activity. A literature review indicated that the intrinsic biomechanical problems of Vancouver B1 fractures have not been thoroughly addressed. Choosing the correct surgical strategy for Vancouver B1 fractures is essential to avoid complications and ensure healing. A sufficient locking plate and cable system should be used after the first failure if revision was not performed the first time.