A 74-year-old man sustained a spiral fracture of the distal third of the femoral shaft after a fall. He has a well-functioning cemented total hip replacement in situ, and radiographs show the fracture lies entirely distal to the tip of a well-fixed femoral stem with no loosening. The best management is:
- A Open reduction and internal fixation with a cable plate construct spanning the stem tip ✓
- B Open reduction and internal fixation with a retrograde intramedullary nail
- C Long-stemmed revision hip arthroplasty
- D Traction followed by functional bracing
Correct answer: A. Open reduction and internal fixation with a cable plate construct spanning the stem tip
Explanation
C fracture distal to the stem tip with a well-fixed prosthesis is Vancouver type A, treated by fixation of the fracture alone without disturbing the implant. Fixation must span proximally past the stem tip using a cable plate or locking compression plate to prevent a stress riser at the stem-fx junction. Revision is reserved for loose stems (types B2 and B3). C retrograde nail is contraindicated because the intramedullary canal is occupied by the stem.
Reference: Rockwood and Green's Fractures in Adults / Miller's Review of Orthopaedics, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.