The Journal of Bone and Joint Surgery, Vol 57, Issue 4 494-501, Copyright © 1975 by Journal of Bone and Joint Surgery, Inc
Femoral fractures in conjunction with total hip replacement
RD Scott, RH Turner, SM Leitzes and OE Aufranc
We reviewed thirty-eight cases, in thirty-six patients, of fracture of the
femur distal to the base of the neck incurred in conjunction with total hip
replacement. There were thirteen preoperative, eighteen intraoperative, and
seven postoperative fractures. The cases were contributed by thirteen
surgeons. We found that the preoperative fractures with pre-existing
disease in the hip joint were effectively treated by primary total hip
replacement using custom-made femoral components with long necks or long
stems, or both. The intraoperative femoral fractures usually occurred while
the surgeon was reaming the canal, seating the femoral component, or
manipulating the femur in patients who were predisposed to fracture.
Theoretically these lesions can be treated like preoperative fractures, but
this demands immediate access to custom-made femoral components with long
necks or long stems, or both, along with an appreciation of the extent and
significance of the fracture. Inadequate fixation was found to lead to
painful non-union or late loosening of the femoral component in four of
eighteen patients. Postoperative fractures occurred too rarely for us to
draw any definite conclusions about management, except to say that surgical
treatment can be hazardous and traction has been successful in this series
and in other reports. Prophylactic measures, however, may help to prevent
postoperative femoral fractures. Most of these fractures occur through a
cortical defect near the tip of the femoral component. A long-stem femoral
component may help to prevent postoperative fractures whenever a proximal
cortical defect of the femur is present preoperatively or is created at
surgery.
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