Authors of section


Derek Donegan, Michael Huo, Michael Leslie

Executive editor

Michael Baumgaertner

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Fracture of the femur distant to the implant

General considerations

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.

Vancouver C femoral fracture


These can be low energy fragility fractures or high energy fractures associated with trauma. Pathologic fracture must always be considered.

Clinical signs

  • Deformity of the lower limb
  • Ecchymosis
  • Pain
  • Leg length discrepancy


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.

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