Modified lever extraction technique for management of a rare femoral prosthesis fracture at the shoulder-neck junction: A case report.

Fractures involving the shoulder-neck junction of the femoral component in total hip arthroplasty are extremely rare with only 25 reported cases identified in existing literature by Van Doesburg et al. Extraction of a well-fixed fractured femoral component, particularly when cemented, is a technically demanding and time-intensive procedure that carries a considerable risk of damage to the host bone. Despite the availability of various described techniques, removal of a broken femoral stem while preserving host bone integrity remains one of the most challenging aspects of revision hip arthroplasty. The authors present a case involving a 62-year-old man with acute pain because of femoral stem fracture at the shoulder-neck junction; managed using a three-step modified lever extraction technique to remove the fractured prosthesis while preserving the surrounding bone. Following fragment removal, a cement-in-cement revision was performed, and the patient was mobilised early. At six weeks, follow-up radiographs were satisfactory, with no early complications observed. The authors suggest that in shoulder-neck junction prosthetic fractures, where the retained fragment is proximally accessible and the cement mantle remains intact, this technique represents a reproducible, bone-sparing, and conservative option. This technique should be considered alongside other established extraction methods rather than as a replacement.