X-rays on presentation to our office are below, showing diaphyseal incarceration, incomplete seating, varus positioning, lateral stress shielding (red arrow) and callus in the area of a medial proximal diaphyseal fracture (light arrows).
The axillary view shows stress shielding (red arrows) and positioning of the component in excessive anteversion.
This case points out some of the technical challenges with a short stemmed prosthesis:
(1) it requires a tight diaphyseal fit - which can create
(a) problems achieving complete seating
(b) stress shielding of the bone proximal to the tight fit
and
(c) risk of fracture on impaction of the prosthesis.
(2) control of the alignment of the prosthesis.
By contrast a long, thin smooth stemmed component fixed with impaction grafting can reduce the risk of these problems
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