Abstract
BACKGROUND: Vancouver type B1 periprosthetic femoral fractures (PFFs) occur in elderly patients with well-fixed femoral stems and present challenges in treatment due to variations in bone quality and fixation methods. This study compared the clinical and radiological outcomes of cemented versus uncemented femoral stems in B1 PFFs treated with open reduction and internal fixation (ORIF) using locking compression plates. MATERIALS AND METHODS: This retrospective analysis included 41 (28 females and 13 males) patients who were treated between 2008 and 2020. Patients were categorized based on femoral stem fixation type. Data on fracture configuration, union time, complications, and Harris Hip Scores (HHS) were analyzed. RESULTS: Transverse fractures were more common in the cemented group, while long oblique fractures predominated in the uncemented group. The cemented group demonstrated longer union times, greater blood loss, and significantly lower HHS (p < 0.001). The mean union time was found to be 23.22 ± 11.25 weeks in the cemented group and 16.28 ± 4.16 weeks in the uncemented group. Nonunion occurred exclusively in patients with cemented stems. Transverse fractures that had previously undergone cemented femoral stem fixation were observed to have a higher risk of nonunion (Odds ratio 2.4; 95% CI: 1.115-5.05, p = 0.02), indicating that the nonunion rate was 2.4 times higher in cases with cemented stems. The uncemented group showed earlier mobilization and better functional outcomes. In the cemented group, significantly longer healing time for PFF (p = 0.017), and increased blood loss (p < 0.001) were observed. The mean blood loss was 381.3 ± 123.48 mL in the cemented group and 218.33 ± 73.5 mL in the uncemented group. CONCLUSIONS: Vancouver type B1 PFFs with cemented femoral stems, particularly transverse fractures, are associated with poorer outcomes and increased nonunion risk following unilateral plate fixation. Stem revision may be considered in such cases. Further multicenter studies are needed to guide optimal treatment strategies.