Association of Surgical Approach with Intraoperative Femoral Fracture Patterns During Cementless Hemiarthroplasty for Femoral Neck Fracture
4 affiliations
- 1Department of Orthopedics and Traumatology, Ankara Dışkapı Training and Research Hospital, Ankara 06110, Türkiye
- 2Department of Orthopedics and Traumatology, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara 06290, Türkiye
- 3Department of Orthopedics and Traumatology, Yuksek Ihtisas University, Ankara 06530, Türkiye
- 4Department of Orthopedics and Traumatology, Mardin Training and Research Hospital, Mardin 47100, Türkiye
Abstract
Background/Objective: Intraoperative femoral fractures during cementless hemiarthroplasty may present with distinct anatomical patterns. We examined whether surgical approach was associated with greater trochanteric versus stem-stable periprosthetic fracture patterns in older patients with osteoporotic-type femoral morphology; stem geometry was evaluated as an additional implant-related factor. Methods: We retrospectively reviewed 292 patients aged ≥75 years who underwent cementless bipolar hemiarthroplasty for low-energy displaced femoral neck fractures at a tertiary referral trauma center between January 2019 and July 2023. Patients were grouped according to stem geometry (fit-and-fill or tapered-wedge) and surgical approach (lateral or posterior). Associations were assessed using multivariable logistic regression, Firth-penalized regression, and stabilized inverse probability of treatment weighting (IPTW). Results: Intraoperative fractures occurred more frequently with the lateral approach than with the posterior approach (23.7% vs. 12.2%; p = 0.015), primarily because of greater trochanteric fractures (9.5% vs. 2.4%; p = 0.016). Periprosthetic fracture rates did not differ significantly between the approaches (14.2% vs. 9.8%; p = 0.284). In the Firth model, the posterior approach was associated with lower odds of greater trochanteric fracture (OR 0.25, 95% CI 0.08–0.80; p = 0.019); after IPTW, the corresponding estimate was OR 0.19 (95% CI 0.05–0.76; p = 0.019). Conclusions: The surgical approach was primarily associated with greater trochanteric fractures, whereas no independent association was observed with stem geometry. Pattern-specific analysis may provide a clearer characterization of intraoperative fracture associations in this setting.
Related
- Comparison of Mortality and Revision Rates between Cemented and Cementless Fixation in Bipolar Hemiarthroplasty: A Nationwide Cohort Study
- Fracture Morphology and Extraction-Related Femoral Damages in Short Versus Standard Cementless Stems: Analyses of Vancouver B2 Fractures and Well-Fixed Nonfracture Revisions
- Total Hip Arthroplasty Is Associated With Lower 90-Day Inpatient Readmission Than Hemiarthroplasty for Femoral Neck Fracture in Patients Aged 65-75 Years: A Propensity Score-Matched Nationwide Readmissions Database Study
- Final Femoral Rasp Predicts Intraoperative Stem Alignment in Primary Total Hip Arthroplasty Using a Cementless Triple-Tapered Stem.
- Early Post-operative Fracture of Titanium Cementless Tibial Baseplate: Case Report and Review of the Literature.
BibTeX
@article{tecirli2026association,
title = {{Association of Surgical Approach with Intraoperative Femoral Fracture Patterns During Cementless Hemiarthroplasty for Femoral Neck Fracture}},
author = {Ali Tecirli and Seyyid Serif Unsal and Tugrul Yildirim and Alp Karacoban},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197666},
url = {https://europepmc.org/article/PMC/PMC13666352},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of Surgical Approach with Intraoperative Femoral Fracture Patterns During Cementless Hemiarthroplasty for Femoral Neck Fracture
AU - Ali Tecirli
AU - Seyyid Serif Unsal
AU - Tugrul Yildirim
AU - Alp Karacoban
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197666
UR - https://europepmc.org/article/PMC/PMC13666352
AB - Background/Objective: Intraoperative femoral fractures during cementless hemiarthroplasty may present with distinct anatomical patterns. We examined whether surgical approach was associated with greater trochanteric versus stem-stable periprosthetic fracture patterns in older patients with osteoporotic-type femoral morphology; stem geometry was evaluated as an additional implant-related factor. Methods: We retrospectively reviewed 292 patients aged ≥75 years who underwent cementless bipolar hemiarthroplasty for low-energy displaced femoral neck fractures at a tertiary referral trauma center between January 2019 and July 2023. Patients were grouped according to stem geometry (fit-and-fill or tapered-wedge) and surgical approach (lateral or posterior). Associations were assessed using multivariable logistic regression, Firth-penalized regression, and stabilized inverse probability of treatment weighting (IPTW). Results: Intraoperative fractures occurred more frequently with the lateral approach than with the posterior approach (23.7% vs. 12.2%; p = 0.015), primarily because of greater trochanteric fractures (9.5% vs. 2.4%; p = 0.016). Periprosthetic fracture rates did not differ significantly between the approaches (14.2% vs. 9.8%; p = 0.284). In the Firth model, the posterior approach was associated with lower odds of greater trochanteric fracture (OR 0.25, 95% CI 0.08–0.80; p = 0.019); after IPTW, the corresponding estimate was OR 0.19 (95% CI 0.05–0.76; p = 0.019). Conclusions: The surgical approach was primarily associated with greater trochanteric fractures, whereas no independent association was observed with stem geometry. Pattern-specific analysis may provide a clearer characterization of intraoperative fracture associations in this setting.
SN - 2077-0383
ER -