Sequential femoral complications in an elderly female: From failed PFN to THR and periprosthetic fracture managed with GTR plating
Bibliographic record
Abstract
Introduction: Periprosthetic femoral fractures following total hip replacement (THR) present a complex challenge, particularly after prior failed fixation. Vancouver type B1 fractures, characterized by a stable femoral implant, are typically treated with open reduction and internal fixation (ORIF). However, management becomes more complex when fractures involve residual trochanteric fragments from prior surgeries. Case Report: A 67-year-old woman sustained a right intertrochanteric femur fracture in September 2024, treated initially with proximal femoral nailing (PFN). The implant failed within two months, prompting conversion to a THR in December 2024 using a standard-length stem. Associated fracture fragments were not addressed during the THR. In May 2025, after a minor fall, she sustained a periprosthetic femoral fracture at the stem level, classified as Vancouver B1. Radiographs and CT confirmed a well-fixed implant. She underwent ORIF using a Greater Trochanteric Reconstruction (GTR) plate with proximal cerclage cables and distal bicortical screws. No infection was present. The patient demonstrates good functional recovery and is able to gradually bear weight after 6 weeks. Discussion: This case highlights the elevated risk of periprosthetic fracture following conversion THR after failed PFN. The stable stem allowed for B1 classification, permitting ORIF without the need for stem revision. The use of a GTR plate provided stable fixation even in the presence of residual trochanteric fragments, facilitating early mobilization and successful fracture union. Conclusion: ORIF using a GTR plate and cable construct can be an effective solution for Vancouver B1 periprosthetic fractures, particularly in complex cases following failed hip fixation. Stable fixation without stem revision offers a pathway to good functional recovery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".