RT info:eu-repo/semantics/article
T1 Internal fixation versus revision arthroplasty for Vancouver B2–B3 fractures: mortality and functional outcomes in frail patients. Insights from the PIPPAS study of 485 patients
A1 Moreta, Jesús
A1 Aguado Hernández, Héctor José
A1 Castillón Bernal, Pablo
A1 Muñoz Vives, Josep M.
A1 Camacho Carrasco, Pilar
A1 Jornet Gibert, Montsant
A1 Teixidor, Jordi
A1 Pereda Manso, Adela
A1 García Sánchez, Yaiza
A1 Ojeda Thies, Cristina
A1 García Portabella, Pablo
A1 Álvarez, Elvira Mateos
A1 Noriega González, David César
A1 Muñoz-Moreno, María-Fe
A1 Arroyo-Hernantes, Irene
A1 Álvarez Ramos, Begoña Aranzazu
A1 García-Medrano, Belén
A1 Martínez-Sellés, Carmen
A1 Marín-Jiménez, Sergio
A1 García Virto, Virginia
A1 País Ortega, Sergio
A1 Acha, Adriana
A1 Tomás Hernández, Jordi
A1 Selga Marsà, Jordi
A1 Andrés Peiró, José Vicente
A1 Piedra-Calle, Carlos
A1 Blasco-Casado, Ferrán
A1 Guerra-Farfán, Ernesto
A1 Querolt Coll, Jordi
A1 de Santamaría, Guillermo Triana-López
A1 Hernández, José M.
A1 Renau Cerrillo, Marina
A1 Gil-Aliberas, Carles
A1 Carreras Castañer, Anna
A1 Vives Barquiel, Marian
A1 Fernández, Eliam Ajuria
A1 Manzano, Eugenia Fernández
A1 De Cortázar, Unai García
A1 Arrieta, Mirentxu
A1 Escobar, Daniel
A1 Castrillo, Estíbaliz
A1 Balvis Balvis, Patricia
A1 Denisiuk, Maciej
A1 Menéndez, Manuel Castro
A1 Pastor, Sonsoles
A1 Larrazábal, Ane
A1 Olías López, Beatriz
A1 Amaya-Espinosa, Patricia
A1 Boluda Mengod, Juan
A1 González Martín, David
A1 López Dorado, Daniel
A1 Borrás Cebrián, Juan Carlos
A1 Martínez-Pérez, Carles
A1 Pazmiño, Patricio Andrés Freile
A1 Calavia-Calé, Pablo
A1 Suárez-Suárez, Miguel Ángel
A1 Lanuza Lagunilla, Lucía
A1 Arias, Antonio García
A1 Cabria-Fernández, Julián
A1 García Coiradas, Javier
A1 Valle Cruz, José
A1 del Saz, Jaime Sánchez
A1 Mora Fernández, Jesús
A1 Lalueza-Andreu, Pedro
A1 Bonome-Roel, César
A1 Cano Leira, María Ángeles
A1 Carrasco, Antonio Benjumea
A1 Pariza, Ana López-de
A1 Fernández Juan, Alexis
A1 la Puente, Carmen Sevillano-de
A1 Juldain-Mondragón, Miren
A1 Arsuaga, Jorge Guadilla
A1 Saura-Sánchez, Eladio
A1 Giménez-Ibáñez, Sandra
A1 Sánchez-Gómez, Plácido
A1 Ricón-Recarey, F. Javier
A1 García García, Elena M.
A1 Cuadrado  Abajo, Francisco
A1 Pérez-Núñez, María Isabel
A1 Pozo Manrique, Pedro del
A1 Navas-García, Francisco Manuel García
A1 García Paredero, Ester
A1 Guijarro Valtueña, Ainhoa
A1 Robles, Teresa Beteta
A1 Navas Pernía, Inés
A1 De Villasante-Jirón, Ignasi
A1 Porta, Teresa Serra
A1 Becerra, Carmen Carrasco
A1 Otero Naveiro, Víctor
A1 Paz, Silvia Pena
A1 Castrillo, Inés Fernández-Billón
A1 Fernández Dorado, Fátima
A1 Martínez Menduiña, Amaia
A1 Vaquerizo-García, Víctor
A1 Murcia Asensio, Antonio
A1 Galián Muñoz, Elena
A1 Marín-Martínez, Carmelo
A1 Muñoz Vicente, Adrián
A1 Plaza Salazar, Nuria
A1 Gámez Asunción, Carla
A1 Benito Santamaría, Jennifer
A1 Salgado-Tarrida, Paula
A1 Prats-Puente, Oriol
A1 Cuenca Copete, Alejandro
A1 González Montero, Blas
A1 Giraldo Vegas, Luis Alejandro
A1 Mingo Robinet, Juan
A1 Briso-Montiano, Ricardo
A1 Barbería-Biurrun, Amaya
A1 Escudero Martínez, Emma
A1 Chouza-Montero, Laura
A1 Naharro Tobío, María
A1 Gasset-Teixidor, Alfons
A1 Domínguez-Ibarrola, Andrea
A1 Peñalver, J. M.
A1 Serrano Sanz, Jorge
A1 Roche-Albero, Adrián
A1 Martín Hernández, Carlos
A1 Macho Mier, María
A1 Saló Cuenca, José Carlos
A1 Roselló, Jordi Espona
A1 Criado Albillos, Guillermo
A1 Cabello Benavides, Hugo Gabriel
A1 Nestar, David Alonso
A1 González-Bernal, Jerónimo
A1 González-Santos, Josefa
A1 Cunchillos Pascual, Jorge
A1 Blasco, Jorge Martínez-Íñiguez
A1 Bogallo-Dorado, José Manuel
A1 Ramírez-Roldán, Alicia
A1 Cano-Porras, Juan Ramón
A1 Marqués López, Fernando
A1 Martínez Díaz, Santos
A1 Slullitel, Pablo I.
A1 Carabelli, Guido S.
A1 Astore, Ignacio
A1 Boietti, Bruno Rafael
A1 Córdova Peralta, Julio César
A1 Hernández Pascual, Carlos
A1 Rodríguez-Gangoso, Alfredo
A1 Dot Pascuet, Iván
A1 Piñeiro-Borrero, Ana
A1 Pérez-Sánchez, José María
A1 Mandía Martínez, Alfonso
A1 Caso Rodríguez, Julio de
A1 Martín Marcuello, Jordi
A1 Benito Mateo, Miguel
A1 Alda-Gastiain, Oiane
A1 Corcuera-Elosegui, Irene
A1 González Panisello, María Rosa
A1 Pérez-Salazar, Nicolás Elizalde
A1 De Sande-Díaz, María
K1 Periprosthetic fracture
K1 Orthogeriatrics
K1 Vancouver B2 fracture
K1 Vancouver B3
K1 Mortality
K1 Revision
K1 Fixation
K1 Frailty
K1 Weight-bearing
K1 Total hip arthroplasty
AB BackgroundPeriprosthetic femoral fractures following hip arthroplasty (FH-PPF) represent a severe complication, especially in elderly patients with compromised health. Traditionally, revision arthroplasty is recommended for B2–B3 FH-PPF, yet internal fixation has emerged as a debated alternative in select patients. The hypothesis was that fixation, in selected patients with B2–B3 FH-PPF, decreases mortality and surgical complication rates with the same functional outcomes as revision arthroplasty.Materials and methodsPIPPAS is a multicenter prospective observational study. This cohort substudy includes 485 patients across 57 hospitals with B2–B3 FH-PPF between January 2021 and May 2023. Management strategy, revision or fixation, was at the attending surgeon’s discretion. Propensity score matching, controlled for age, age-adjusted Charlson Comorbidity Index (a-CCI), prefracture mobility, Pfeiffer scale, and ASA score, was done. Mortality risk factors were assessed using univariate and multivariate analysis.ResultsOut of 485 patients, 164 received fixation, and 321 underwent revision. Fixation patients were older (88 versus 82 years, p < 0.001) and frailer. Fixation was associated with shorter hospital stay (13 versus 15 days, p = 0.003) but higher 1-year mortality (25% versus 14.3%, p = 0.04). There were no differences in medical or surgical complications (p = 0.83 and p = 0.36) at any time, but dislocation rate was higher in the revision group (p = 0.001). The 1-year mortality rate in patients with no weight-bearing restrictions was higher for the revision group (p = 0.01). The propensity score matching showed higher 1-year mortality rate in the fixation group but no differences in functional outcomes, complications, or up to 6-months mortality. In the multivariate analysis a-CCI, cognitive impairment, B3 fractures, and prefracture independent walking impairment were independent mortality risk factors.ConclusionsRevision arthroplasty showed less 1-year mortality rate and weight-bearing restrictions than fixation. However, frail patients with B2–B3 FH-PPF managed with fixation allowing full weight-bearing showed a lower 1-year mortality rate. Fixation in B2–B3 FH-PPF is a treatment option in frail patients, while aiming for stable constructions allowing full weight-bearing.
PB Springer
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/81221
UL https://uvadoc.uva.es/handle/10324/81221
LA eng
NO J Orthop Traumatol. 2025, 22;26(1):78.
NO Producción Científica
DS UVaDOC
RD 06-abr-2026