Derek Donegan, Michael Huo, Michael Leslie
Simple or comminuted fracture patterns distal to the stem are classified as type IV.3-C fractures by UCPF. These fractures are independent of the prosthesis.
These can be low energy fragility fractures or high energy fractures associated with trauma. Pathologic fracture must always be considered.
Full length AP and lateral radiographs of the femur usually reveal the complexity of the fracture. CT scan may be relevant if the fracture could be intraarticular at the knee.
Look for asymmetric liner wear and associated osteolysis.