Is there a place for conservative treatment of a Vancouver B2 fracture around a cemented polished tapered stem

Background Revision of the unstable stem of a total hip replacement following a peri-prosthetic fracture of the femur is a complex procedure with a high complication rate. With this study we aim to describe the radiologic findings of a specific fracture around polished tapered stems. Methods Eight male patients presented with a painful hip replacement after a fall. Standard radiographs did not show any signs of a fracture. CT scans showed a complex burst fracture in all cases. Conservative treatment was initiated for at least 6 weeks. A cement-in-cement revision was conducted at 3 months in case the patient was not pain free. Results After 3 months none of the fractures had displaced, neither had the stem subsided. Five patients were pain free and did not require surgical intervention. One patient underwent a cement-in-cement stem revision because of persistent pain. Conclusion Normal radiographs of a post-traumatic and painful polished tapered stem do not exclude a Vancouver type B2 fracture and should be followed by a CT-scan. Cement cracks, eccentric gaps and subsidence are highly suspicious signs for a non-displaced fracture pattern. Conservative treatment remains an option for these fractures and can be followed by a cement-in-cement stem revision after fracture healing, if this is still required.