Objective: To study the pathogenesis, treatment and prevention of intraoperative femur fracture.
Methods: Intraoperative femur fracture occurred in 25(2.6%) of 945 hip arthroplasties performed from 1972 to 1996. 142(5.6%) occurred in revision arthroplasties, 12 (2.4%) 493 primary arthroplasties (2.4%), and 5(1.3%) in 310 semi-arthroplasties.
Results: The causes of these fractures included osteoporosis, iatrogenic, congenital alteration of bony anatomy, and inadequate soft tissue release prior to hip dislocation during revision of hip surgery. Femoral fractures can be prevented by preoperative templating of rontgenograms containing markers to measure magnification; routine overdrawing of the femoral canal when implanting long-stemmed prostheses; and a more extensive release of the external rotators and other scar tissue performed prior to dislocation. Any structures preventing free rotation of the femur should also be considered for the release.
Conclusions: We recommend that intraoperative roentgenograms be made whenever preparation of the femoral canal or impacting of the prosthesis is more difficult or when resistance is suddenly lost during implication of implant. When diagnosed intraoperatively, it should be fixed with cerclage wiring. When an incomplete fracture near the hip of the stem was discovered postoperatively and the posterior part of the femoral cortex was intact, a spica cast was applied. For a complete fracture at the tip of stem, we recommend open reduction and internal fixation.