FEMORAL FRACTURES ASSOCIATED WITH MOORES PROSTHESIS

Thirty cases of fracture of the femur occurring in patients following Moore's arthroplasty have been reported. The fracture patterns can be classified according to the relationship of the fracture line to the stem's tip. Type I fractures occur in the intertrochanteric area and are stable since both femoral fragments are held by the prosthesis. Type II fractures occur between the trochanteric line and the stem's tip and are also stable; the more proximal the fracture, the greater the stability. Type III fractures are grossly unstable since the prosthetic stem has no purchase on the distal femur. Type I and type II fractures can be treated successfully in traction, and complications, particularly in type I injuries, are uncommon. Type III fractures are difficult to treat. The complication rate for these fractures was 56 per cent, including five deaths. Most major complications occurred in patients treated by traction. Operative management appears to be the best treatment for these injuries so that the complications of prolonged bedrest can be avoided. Although a variety of operative methods have been attempted, replacement with a long-stemmed Moore's prosthesis, intramedullary bone cement and cerclage wiring is recommended. Operative treatment is not without hazard, however, and should be undertaken only if stabilization of the fracture can be assured. Since complications of both operative and conservative treatment are common, attention should be directed towards prevention. © 1980 John Wright & Sons Ltd. All rights reserved.