Incidence of intraoperative femoral fracture. Straight-stemmed versus anatomic cementless total hip arthroplasty.

The authors report the incidence of intraoperative femoral fractures (16 cases) occurring during the course of 395 cementless total hip arthroplasties performed at the Rizzoli Orthopaedic Institute between November, 1980 and June, 1991. The straight stem (Lord prosthesis) caused an intraoperative fracture in 18% of the cases, whereas the anatomic stem (An.C.A.) caused a fracture in only 1.5% of the cases. An intraoperative fracture occurred in 13% of patients with osteoporosis and only in 1.4% of those with normal mineralization of the proximal femur. Seven cases required circlage wiring; one was treated with interfragmentary screws (in the diaphysis). The remaining patients were treated with casting or delayed weight-bearing. Fifteen fractures consolidated within an average of 10 weeks. One case treated with circlage wiring and screws resulted in a nonunion. After 7 months, internal fixation with a plate and screws was performed with consolidation 5 months later. All stems were radiographically stable at an average follow-up of 40 months.