SURGICAL-MANAGEMENT OF INTRAOPERATIVE AND POSTOPERATIVE FRACTURES OF THE FEMUR ABOUT THE TIP OF THE STEM IN TOTAL HIP-ARTHROPLASTY

Six techniques for the surgical management of fractures of the femur a bout the tip of the stem of a total hip arthroplasty were evaluated. S even embalmed human femurs were prepared to receive the correct-size f emoral component of a total hip system. A transverse osteotomy was per formed at the level of the tip of the stem. Stability and strength of each reconstruction were tested on each femur under semidynamic loadin g conditions. This study showed that cementless revision to a long-ste m prosthesis does not provide adequate stability. The highest strength and stability were achieved by supplementing the long-stem conversion with allograft struts and cable cerclage. Good results were obtained by lateral compression plating with unicortical screws proximally. Fai lure was due to pull-out of the proximal screws.