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Dr. Ebraheim’s educational animated video describes the periporsthetic fracture of the femur in a simple and easy way. Vancouver classification for postoperative periosteopathic femur fractures. Fractures around the total hip prosthesis are occurring more frequently. Vancouver classification is the most classification used (very popular on exam). Vancouver classification relies on the level of the fractures, if the prosthesis is stable or not and the quality of the bone. Vancouver classification is (A) Proximal femur trochanteric area (B) Fracture occurs at or near the distal tip of the hip prosthesis. (C) Occurs well below the hip prosthesis Type Ag •Proximal femur greater trochanteric area. •Fractures in the trochanteric region can be stable and can usually be treated conservatively. •If the fracture is migrated 2.5 cm, it probably will need surgery. •Do surgery for displacement of the fracture or instability of the prosthesis. •Nonunion is associated with pain, instability, weak abduction and gait disturbances. Type AL •Fracture in the lesser trochanteric region. •Usually symptomatic treatment •Check stability of the prosthesis •If substantial aspect of the medial part of the femur is included with the lesser trochanter, revision of the total hip arthroplasty with reconstruction of the medial buttress may be necessary. Type (B) •Fracture occurs at or near the distal tip of the hip prosthesis. •There are three types: Type B1: stable stem. B1 is associated with the most complications of all the fracture types because the fractures are usually unstable. Type B1 treatment: ORIF using a cerclage cable or locking plate. Type B2: loose stem, fracture occurs ar or near the distal tip of the hip prosthesis. It is very difficult to differentiate between type B1 and type B2 based on x-rays alone. Type B2 treatment: revision to long, porous, cementless stem. Type B3: loose stem and proximal is poor quality or severely comminuted fracture. Type B3: treatment: revision of the femoral component with proximal femoral allograft or proximal femoral replacement. Type C •occurs far below the hip prosthesis •Type C treatment: ORIF with a plate. If the physician can bypass a perforation utilizing a prosthesis that ends 2-3 femoral shaft diameters distal to the perforation, this will reduce the risk of fracturing through the perforation. Become a friend on facebook: / drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Background music provided as a free download from YouTube Audio Library. Song Title: Every Step