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open reduction and internal fixation with strut graft and cerclage wire.
12%
31/265
open reduction and internal fixation with a plate, screws, and bone graft.
16%
42/265
exchange of the femoral components with insertion of a long stem cementless implant.
23%
62/265
cast immobilization.
0%
1/265
minimal weight bearing and observation.
46%
121/265
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Intraoperative femoral fractures can often be avoided by careful preoperative planning to optimize implant design and size. Most fractures occur during implantation of a cementless implant; many can be avoided by careful femoral preparation and component implantation, with particular caution in osteopenic bone. Intraoperative femoral fractures are managed according to fracture severity. Minor cracks that do not affect stability or femoral integrity can often be managed intraoperatively with cerclage fixation, limited weight bearing, and observation. Femoral fractures that compromise implant stability or femoral integrity require fracture fixation with cerclage wires, strut grafts, or plates and may require conversion to a long stem implant. This patient’s fracture is nondisplaced and the implant is well seated; therefore, limited weight bearing is considered appropriate management.
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