Simple or comminuted fracture patterns at or around an unstable stem with good bone stock are classified as type IV.3-B2 fractures by UCPF. The remaining bone can support stem revision and fracture repair.
These fractures can occur during the index surgery, or from trauma. In high energy trauma, consideration should be given to ATLS protocols to diagnose other potential injuries.
Pathologic fracture must always be considered.
Deformity of the lower limb
Leg length discrepancy
AP and lateral radiographs usually reveal the complexity of the fracture. When the fracture extends more proximally, a CT scan can be helpful to delineate lines that extend between the trochanters. Most important is a review of any prior radiographs of the hip replacement which can allow for evaluation of stability. If any changes are noted between the prior set of radiographs and the injury films, the stem should be considered unstable and revision is the appropriate treatment. Evaluation of bone stock is necessary to determine appropriate surgical treatment plan.
Look for asymmetric liner wear and associated osteolysis.