Failed internal fixation due to osteonecrosis following traumatic periprosthetic fracture after hip resurfacing arthroplasty

A 55-year-old man had undergone a Birmingham Hip Resurfacing (Cup 56, Head 50; BHR; Smith and Nephew TLC, London, UK) for primary osteoarthritis. The index procedure and postoperative healing were uneventful and radiographs showed well-fixed femoral and acetabular components.

18 weeks after surgery, the patient was involved in a motorcycle accident and fell on the operated hip. An undislocated vertical fracture of the femoral neck was treated surgically to preserve the prosthesis. As the centrally located implant stem might cause difficulty with the placing of typical implants (e.g. screw-plate device or a cephalomedullary nail), 3 parallel cannulated cancellous screws in a triangular configuration (Figure 1A) were used for fixation of the fracture. Care was taken to avoid contact between the implanted stainless steel screws and both the stem and lateral walls of the femoral component. The patient was operated on 14 h after the injury.