Intraoperative Periprosthetic Proximal Femoral Fractures During Direct Anterior Approach: A New Screw and Plate Fixation Method

Background: Intraoperative periprosthetic proximal femoral fractures (PPFFs) represent a significant complication during total hip arthroplasty (THA), especially when using cementless stems via a direct anterior approach (DAA). Methods: This retrospective case series evaluated 10 patients with Vancouver A2 PPFFs treated with 2.7 mm lag screws alone or in combination with plates during DAA THA or partial hip arthroplasty between January 2021 and March 2024. Results: All fractures healed. One patient experienced 1 cm of stem subsidence without the need for revision. The mean Harris Hip Score improved from 35.4 preoperatively to 85.6 postoperatively. Functional recovery and radiological stability were comparable between fixation methods, though the screw-only group experienced slightly more postoperative pain. Patients in the screw-and-plate group were significantly older than those in the screw-only group (p = 0.026). No significant differences were found between groups regarding surgical time (p = 0.62) or BMI (p = 0.82). Due to the limited number of subsidence events, the statistical comparison of subsidence rates was inconclusive. Conclusions: In this preliminary retrospective case series, the use of 2.7 mm lag screws and small locking plates appeared feasible and was associated with favorable short-term outcomes in selected Vancouver A2 intraoperative PPFFs during DAA. These findings are hypothesis-generating and require confirmation in larger, prospective comparative studies.