Intraoperative modular stem lengthening to treat periprosthetic femur fracture.

Fracture of the femur around a femoral prosthesis can be a difficult problem to manage. Treatment options consist of traction, allograft struts, or plating with cerclage fixation, and revision arthroplasty. Intramedullary stabilization is usually preferable to plating for treatment of diaphyseal femur fractures; however, for a fracture around a cementless stem, disruption of the biologically fixed proximal area of the implant and revision to a long-stem component are generally required to permit intramedullary fixation of the fracture. Many modular femoral stems are currently available. Some of these have both proximal and distal modular options. Distal modularity provides the surgeon treating a fracture around a femoral component with a unique opportunity to lengthen the stem during surgery by adding an attachment to the distal stem through the fracture site.