A 70-year-old woman falls onto her flexed knee 4 years after total hip arthroplasty. Radiographs show an oblique fracture of the femoral shaft entirely below the tip of a well-fixed cemented stem, displaced by more than one shaft width. The preferred management is:

• A Revision hip arthroplasty with a long-stemmed femoral component
• B Open reduction and internal fixation with a retrograde intramedullary nail placed past the stem tip ✓
• C Closed treatment in a cast brace with restricted weight bearing
• D Cement-in-cement stem exchange through a cortical window

Explanation

This is a Vancouver type C fracture: it lies entirely distal to the stem and does not involve the prosthesis-bone interface. Because the implant is unaffected, the fracture is managed like any distal femoral shaft fracture, typically with open reduction and internal fixation using a plate or a retrograde nail passed beyond the stem. Revision arthroplasty is reserved for fractures involving the stem itself, which kills option A.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.