Vancouver Classification Periprosthetic Hip Fractures

Last updated: July 6, 2026Reviewed date: July 6, 2026Reading time: 6 min read
Patient Tools

Read, save, and share this guide

Use these quick tools to make this medical article easier to read, print, save, or share with a family member.

Article Summary

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...

Key Takeaways

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

RX Patient Tools

Use these quick guides before reading the article, or return to them when you need help preparing questions for a doctor.

Start here Choose the right pathway for symptoms, reports, medicines, or urgent warning signs. Disease article roadmap Read this topic step by step: meaning, symptoms, warning signs, diagnosis, treatment, prevention, and follow-up. Treatment planner Prepare questions about treatment choices, benefits, risks, side effects, and follow-up. Family & caregiver guide Organize symptoms, reports, medicines, questions, and follow-up safely. Nutrition & diet guide Prepare food, hydration, supplement, and medicine-timing questions safely. Prevention guide Organize risk factors, protective habits, screening, and warning signs. Recovery guide Prepare a safe plan for activity, rehabilitation, warning signs, and follow-up.
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.
Choose your reading view

Patient View highlights a simple learning journey. Clinical View reveals structure, evidence, and editorial completeness.

Definition

The Vancouver classification means the periprosthetic hip fractures, or post-operative periprosthetic femoral 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 , 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

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

or

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 , 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)

or

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 Vancouver Classification Periprosthetic Hip Fractures Vancouver Classification Periprosthetic Hip Fractures

References

RX Medical Knowledge Graph

Explore this medical topic

Continue through verified related conditions, investigations, medicines, and patient guides. These links are educational and do not replace professional medical advice.

Related medical topics

Cooke and Newman Classification of Periprosthetic Hip Fractures83% relationship confidence Johansson Classification of Periprosthetic Hip Fractures83% relationship confidence Garden Classification of Subcapital Femoral Neck Fractures78% relationship confidence Meyers and McKeever's Classification of ACL avulsion fractures78% relationship confidence Distal Radius Fractures - Causes, Symptoms, Treatment73% relationship confidence Femur Neck Fractures - Causes, Diagnosis, Treatment73% relationship confidence Fractures of the naso-orbital-ethmoid (NOE) complex73% relationship confidence Frontal Sinus Fractures - Causes, Symptoms, Treatment73% relationship confidence
More from this topic
  1. Zygomaticomaxillary Fractures

    DefinitionA zygomaticomaxillary fracture?—often called a ZMC fracture or tripod/tetrapod fracture—is a break of the cheekbone where the zygoma (cheekbone) meets the maxilla (upper jaw) and the...

    August 31, 2025 • Rx Fracture of Bone (A - Z)
  2. Orbital Roof Fractures

    DefinitionThe orbital roof is the bony “ceiling” of the eye socket. It is made mainly by the frontal bone. It separates the eye from the front...

    August 19, 2025 • Rx Fracture of Bone (A - Z)
  3. Orbital Medial Wall Fractures 

    DefinitionAn orbital medial wall fracture? is a break in the thin bone on the inner side of the eye socket. The eye socket is the orbit....

    August 19, 2025 • Rx Fracture of Bone (A - Z)
  4. Orbital Floor Fractures 

    DefinitionAn orbital floor fracture? is a break in the thin bone that makes the “bottom” of the eye socket. Your eye sits in a bony cup...

    August 19, 2025 • Rx Fracture of Bone (A - Z)
  5. Cough-Induced Rib Fractures

    DefinitionA cough?-induced rib fracture? happens when repeated, forceful coughing (or one severe? cough) places very high stress on the rib cage?. The muscles between the ribs...

    August 15, 2025 • Rx Fracture of Bone (A - Z)
  6. Naso-orbitoethmoid (NOE) Complex Fracture

    DefinitionA naso-orbitoethmoid (NOE) complex fracture? is a break of the thin bones in the middle of the face where the top of the nose meets the...

    August 14, 2025 • Rx Fracture of Bone (A - Z)
  7. LeFort Fractures

    DefinitionLeFort fractures are specific break patterns in the middle of the face (the “midface”). They were first mapped by a French surgeon, René Le Fort, who...

    August 11, 2025 • Rx Eye & Vision Care (A - Z)
  8. Vertical Root Fractures

    DefinitionVertical Root Fractures (VRF) are dental issues that can cause severe? pain? and damage to your teeth. In this article, we’ll break down everything you need...

    December 31, 2023 • Rx Fracture of Bone (A - Z)
  9. Tooth Fracture

    DefinitionTooth fractures can be painful and worrying, but understanding them can help you take better care of your oral health. In this article, we’ll provide you...

    December 31, 2023 • Rx Fracture of Bone (A - Z)
  10. Fracture Blister

    DefinitionA fracture? blister? can happen when a bone breaks, and it’s important to understand what it is, what causes it, and how to deal with it....

    December 14, 2023 • Rx Fracture of Bone (A - Z)
RX Clinical Pathway Engine

Continue through a complete learning pathway

Move from understanding the topic to symptoms, tests, treatment, medicines, monitoring, and prevention.

Search the complete library
  1. Understand the condition Begin with the essential facts and a clear explanation of the topic.
  2. Recognize symptoms Learn common symptoms, signs, and patterns of presentation.
  3. Know when to seek help Review urgent warning signs and when professional assessment may be needed.
  4. Understand causes and risks Explore causes, risk factors, mechanisms, and contributing conditions.
  5. Explore tests and diagnosis Learn how clinicians assess the condition and which investigations may be discussed.
  6. Learn treatment approaches Review general treatment categories and management principles.
  7. Understand medicines safely Continue to medicine education, uses, precautions, and monitoring.
  8. Plan monitoring and follow-up Understand monitoring, complications, rehabilitation, and follow-up learning.
  9. Review prevention and self-care Explore prevention, healthy routines, and questions to discuss with a clinician.

Conditions & Diseases

Background, symptoms, causes, diagnosis, and care.

Explore this library

Tests & Investigations

Laboratory, imaging, screening, and diagnostic education.

No strong indexed relationship is available yet.

Explore this library

Medicines

Uses, safety, monitoring, and related medicine knowledge.

Explore this library

Cancer Knowledge

Cancer types, screening, oncology, and treatment education.

Explore this library
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

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.

Safe pathway to proper treatment

Care roadmap for: Vancouver Classification Periprosthetic Hip Fractures

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

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.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. 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.