Subtrochanteric periprosthetic femoral fracture with a resurfacing metal-on-metal prosthesis in situ in an elderly patient: An increasing problem? - A case report and literature review.

AIMS: Subtrochanteric periprosthetic femoral fractures (PPFF) in elderly patients with metal-on-metal hip resurfacing implants are rare and pose significant management challenges. This case report describes the surgical management of such a fracture and provides a review of reported treatment strategies.

METHODS

A 79-year-old woman with a sixteen-year-old Birmingham Hip Resurfacing (BHR) prosthesis sustained a comminuted subtrochanteric femoral fracture following a fall. The fracture was treated with open reduction and internal fixation (ORIF) using a Locking Compression Plate and cerclage wires. A literature review was conducted to evaluate surgical approaches and outcomes for similar cases.

RESULTS

Postoperatively, the patient mobilized with weight-bearing restrictions and showed satisfactory fracture healing at follow-up, with radiographic consolidation at four months and full functional recovery. The literature review showed that ORIF, primarily using plate osteosynthesis, is the preferred treatment for subtrochanteric PPFFs in resurfacing arthroplasty, yielding good fracture consolidation and mobility outcomes. Total hip arthroplasty (THA) is typically reserved for fractures with implant loosening or insufficient bone quality.

CONCLUSION

ORIF is an effective treatment for subtrochanteric PPFF in elderly patients with stable resurfacing implants, promoting fracture healing and functional restoration. This case underscores the complexity of managing such fractures in aging populations and emphasizes the need for individualized treatment plans. Given the aging population with resurfacing prostheses, further research is needed to optimize treatment strategies and improve patient outcomes.