Vancouver Classification Periprosthetic Hip Fractures

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 6 min read

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Key Takeaways

This article explains Vancouver Classification Periprosthetic Hip Fractures in simple medical language.

Educational health guideWritten for patient understanding and clinical awareness.

Reviewed content workflowUse writer and reviewer profiles for stronger trust.

Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
New weakness, severe pain, high fever, or symptoms after a serious injury.
Any symptom that feels urgent, unusual, or unsafe for the patient.

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

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Definition

The Vancouver classification means the periprosthetic hip fractures, or post-operative periprosthetic femoral fracture diagnosis system proposed by Duncan and Masri is the most widely used classification system. It is a special type fracture managing method for classifying, investigating the fracture pattern, severity, degree, location, type, angulation, shortening – lengthening, comminution, rotation, displacement, the status of the femoral implant, the quality of surrounding femoral soft tissue injury and fracture angle are universally and widely accepted by orthopedic surgeons to assess the initial injury, plan management, and predict prognosis, to manage decision making, in determining whether a fracture requires an intramedullary nail or open reduction with internal fixation with steel screws, rods, plates, pins, or K-wires to hold the broken bones in the correct position even external fixation attaches a metal framework outside the limb and includes the Ilizarov method and an X-frame.

Vancouver Classification Periprosthetic Hip Fractures

type A: fractures involve the trochanteric area
- A(G): greater trochanter
- A(L): lesser trochanter
type B: around the stem or just below it
- B1: stem stable
- B2: stem loose
- B3: stem loss, bone stock inadequate
type C: well below the stem

The Vancouver classification is a fracture grading system used by orthopedics to determine the management of post-operative periprosthetic femoral fractures in hip arthroplasty. It is named for the city Vancouver, home to the University of British Columbia is where the authors of the 1995 paper worked in the orthopedic department.

Vancouver Classification & Treatment – Intraoperative Periprosthetic Fracture
Type	Description	Treatment
A1	Proximal metaphysis, cortical perforation	Bone graft alone (e.g. from acetabular reaming)
A2	Proximal metaphysis, nondisplaced crack	Cerclage wire before inserting stem (to prevent crack propagation) Ignore the fracture if fully porous-coated stem is used (provided there is no distal propagation)
A3	Proximal metaphysis displaced unstable fracture	Fully porous-coated stem, or tapered fluted stem Wires/cables/claw plate for isolated GT fractures
B1	Diaphyseal, cortical perforation (usually during cement removal)	Fully porous-coated stem (bypass by 2 cortical diameters) ± strut allograft
B2	Diaphyseal, nondisplaced crack (from increased hoop stress during broaching or implant placement)	Cerclage wire (if implant stable) Fully porous-coated stem to bypass defect (if implant unstable) ± strut allograft PWB and observation (if detected postop)
B3	Diaphyseal, displaced unstable fracture (usually during the hip dislocation, cement removal, stem insertion)	Fully porous-coated stem to bypass defect ± strut allograft
C1	Distal to stem tip, cortical perforation (during cement removal)	Morcellized bone graft, fully porous-coated stem to bypass defect, strut allograft
C2	Distal to stem tip, nondisplaced fracture	Cerclage wire, strut allograft
C3	Distal to stem tip, displaced unstable fracture	ORIF

Vancouver Classification & Treatment – Postoperative Periprosthetic Fracture
Type	Description	Treatment
A	Fracture in the trochanteric region. Commonly associated with osteolysis. AG (greater trochanter) fractures caused by retraction, broaching, actual implant insertion, previous hip screws.	Often requires treatment that addresses the osteolysis. AG fractures with < 2cm displacement, treat nonoperatively with partial WB and allow the fibrous union. AG fractures >2cm needs ORIF (loss of abductor function leads to instability) with trochanteric claw/cables
B1	Fracture around the stem or just below it, with a well-fixed stem	ORIF using cerclage cables and locking plates
B2	Fracture around the stem or just below it, with a loose stem but good proximal bone stock	Revision of the femoral component to a long porous-coated cementless stem and fixation of the fracture fragment. Revision of the acetabular component if indicated
B3	Fracture around the stem or just below it, with proximal bone that is poor quality or severely comminuted	Femoral component revision with proximal femoral allograft (APC) or proximal femoral replacement (PFR)
C	The fracture occurs well below the prosthesis	ORIF with plate (leave the hip and acetabular prosthesis alone)

Classification for operative process

Type	Description	Treatment
A	Fracture in the trochanteric region	ORIF if displaced
B1	Fracture around the stem or just below, with well-fixed stem	ORIF with cables and plate
B2	Fracture around the stem or just below, with loose stem but good proximal bone	Revision of femoral component
B3	Fracture around the stem or just below, with poor quality or severely comminuted proximal bone	Revision of femoral component with a proximal femoral replacement
C	Fracture below the prosthesis

Vancouver Classification Periprosthetic Hip Fractures

References

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Orthopedic doctor, rheumatologist, or physiotherapist depending on cause.

What to tell the doctor

Write which joints hurt, swelling, morning stiffness duration, fever, injury, and walking difficulty.
Bring X-ray, uric acid, ESR/CRP, rheumatoid factor, or previous reports if available.

Questions to ask

Is this injury, osteoarthritis, rheumatoid arthritis, gout, infection, or another cause?
Which exercises, supports, or lifestyle changes are safe?
Do I need blood tests or X-ray?

Tests to discuss

Joint examination and range of motion
X-ray when chronic arthritis or injury is suspected
ESR/CRP, uric acid, rheumatoid tests when inflammatory arthritis is suspected

Avoid these mistakes

Do not ignore hot swollen joint with fever.
Avoid repeated steroid injections/tablets without a clear diagnosis and follow-up.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Rest, drink safe water, and observe symptoms carefully.
Keep a written note of symptoms, duration, temperature, medicines already taken, and allergy history.
Seek medical care quickly if symptoms are severe, worsening, or unusual for the patient.

OTC medicine safety

For mild pain or fever, ask a registered pharmacist or doctor before using common over-the-counter pain/fever medicines.
Do not combine multiple pain medicines without advice, especially if you have kidney disease, liver disease, stomach ulcer, asthma, pregnancy, or take blood thinners.
Do not give adult medicines to children unless a qualified clinician advises it.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Severe symptoms, confusion, fainting, breathing difficulty, chest pain, severe dehydration, or sudden weakness need urgent medical care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider

Tests to discuss with doctor

Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
Relevant blood, urine, imaging, or specialist tests only after clinical assessment

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first

If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story

Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician

A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests

Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse

If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

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