The use of an interference fit retrograde nail as an adjunct to plate fixation of a complex Vancouver B1 periprosthetic femoral fracture

As the number of hip arthroplasties performed continues to grow, increasingly complex periprosthetic fractures are encountered. In particular, fractures occurring near the tip of a well-fixed stem, classified as Vancouver B1, have been associated with high rates of failure. Numerous treatment strategies have been recommended including traditional plating, locked plating, cortical allografts as well as retrograde nails overlapping the femoral stem tip. The latter technique has been advocated as a less invasive method to stabilise periprosthetic fractures in elderly, lowdemand patients unfit for extensive surgical procedures. Here, we present the use of a retrograde nail overlapping a femoral stem in a young, active patient as supplemental fixation to a lateral plate for the difficult situation of a Vancouver B1 periprosthetic fracture proximal to an femoral shaft hypertrophic nonunion.