Management of periprosthetic proximal femoral fracture of megaprosthesis with limited residual bone stock: A case report.

INTRODUCTION

Periprosthetic fractures involving femoral megaprostheses are complex and challenging to manage due to limited residual bone stock available for fixation. In Indonesia, data on such complications are scarce, and surgical strategies often require adaptation based on resource availability.

CASE PRESENTATION: A 42-year-old man with a history of distal femoral megaprosthesis implantation for a giant cell tumor presented with right hip pain after a low-energy fall. Imaging showed a Vancouver type B3 periprosthetic fracture. The remaining proximal femoral bone stock measured only 7.5 cm, significantly limiting options for internal fixation due to poor surface area and compromised load distribution. Surgical management involved internal fixation using a trochanteric claw plate and cable wires. Dual 8 cm autologous fibular strut grafts were harvested and positioned anteriorly and posteriorly around the fracture site. Postoperative recovery was uneventful. At four-month follow-up, the patient demonstrated excellent progress, with no signs of infection, good range of motion, and absence of pain.

DISCUSSION: This case illustrates the viability of using a trochanteric claw plate and fibular strut grafts to treat periprosthetic fractures around a stable femoral megaprosthesis. The fracture likely occurred due to bone fragility at the cement-bone interface. The combination of mechanical fixation and biological grafting enabled early mobilization while preserving the existing implant.

CONCLUSION

In resource-limited settings, this technique offers a promising limb-salvage strategy with favorable short-term outcomes. Further studies are needed to validate long-term effectiveness.