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Published on: June 6, 2025
Intraoperative Periprosthetic Proximal Femoral Fractures During Direct Anterior Approach: A New Screw and Plate
Filippo Randelli1, Francesco Manzini2, Alberto Fioruzzi1
1Hip Department (CAD), ASST Gaetano Pini-CTO, University of Milan, 20122 Milano, Italy.
Journal of Clinical Medicine
|June 26, 2026
Summary
Fixing intraoperative periprosthetic proximal femoral fractures (PPFFs) during direct anterior approach total hip arthroplasty (THA) using lag screws, with or without plates, showed promising short-term results. All fractures healed, and functional scores improved significantly.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Intraoperative periprosthetic proximal femoral fractures (PPFFs) are a known complication of total hip arthroplasty (THA).
- Cementless stems used with the direct anterior approach (DAA) may increase the risk of PPFFs.
Purpose of the Study:
- To evaluate the feasibility and short-term outcomes of treating Vancouver A2 PPFFs.
- To compare fixation with lag screws alone versus screws and plates in DAA THA.
Main Methods:
- Retrospective case series of 10 patients with Vancouver A2 PPFFs.
- Treatment involved 2.7 mm lag screws, with or without plates, during DAA THA or partial hip arthroplasty.
- Data collected included fracture healing, stem subsidence, Harris Hip Score, and postoperative pain.
Main Results:
- All 10 fractures healed successfully.
- Mean Harris Hip Score improved from 35.4 to 85.6.
- Functional recovery and radiological stability were comparable between fixation groups, with screw-only showing slightly more pain.
Conclusions:
- 2.7 mm lag screws and small plates are feasible for Vancouver A2 PPFFs during DAA.
- Favorable short-term outcomes were observed, warranting further investigation.
- Larger prospective studies are needed to confirm these preliminary findings.
