Lucero CM, Luco JB, Albani Forneris A, Buttaro MA. Recurrent femoral stem fractures in Dorr A femurs: Lessons learned and a call for alternative strategies. World J Methodol 2025; 15(4): 106708 [DOI: 10.5662/wjm.v15.i4.106708]
Corresponding Author of This Article
Juan Bautista Luco, MD, Instituto de Ortopedia y Traumatologia Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires C1198AAW, Buenos Aires, Argentina. bautista.luco@hospitalitaliano.org.ar
Research Domain of This Article
Orthopedics
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. Dec 20, 2025; 15(4): 106708 Published online Dec 20, 2025. doi: 10.5662/wjm.v15.i4.106708
Recurrent femoral stem fractures in Dorr A femurs: Lessons learned and a call for alternative strategies
Carlos M Lucero, Juan Bautista Luco, Agustin Albani Forneris, Martin A Buttaro
Carlos M Lucero, Agustin Albani Forneris, Martin A Buttaro, Centro de Cadera ''Sir John Charnley'' Instituto de Ortopedia y Traumatologia Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Capital Federal C1198AAW, Buenos Aires, Argentina
Juan Bautista Luco, Instituto de Ortopedia y Traumatologia Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires C1198AAW, Buenos Aires, Argentina
Author contributions: Lucero CM served as the principal author of both the current study and the previous related work; Luco JB was responsible for obtaining informed consent and organizing the relevant case documentation; Forneris AA contributed as a secondary writer and assisted in patient follow-up; Buttero MA acted as the senior author, overseeing the project and making the necessary revisions.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Juan Bautista Luco, MD, Instituto de Ortopedia y Traumatologia Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires C1198AAW, Buenos Aires, Argentina. bautista.luco@hospitalitaliano.org.ar
Received: March 5, 2025 Revised: May 4, 2025 Accepted: May 29, 2025 Published online: December 20, 2025 Processing time: 152 Days and 21.3 Hours
Abstract
We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology, underscoring the need for a critical reassessment of implant selection strategies. The initial failure involved a cemented revision stem placed using the cement-within-cement technique combined with an extended trochanteric osteotomy (ETO). A second revision was subsequently performed using a cortical window osteotomy and a distally fixed uncemented stem, which resulted in successful recovery. A similar approach was used to treat a subsequent contralateral stem fracture, also with favorable outcomes. This case emphasizes three key considerations: First, that standard-length cemented stems may lead to oversizing and increased stress concentration in Dorr A femurs with narrow canals; second, that ETO may compromise femoral integrity and contribute to implant failure; and third, that cortical window osteotomy enables safer implant removal and reimplantation. Based on these findings, we advocate for an individualized approach to implant selection that may include cemented short stems, uncemented short stems, or modular solutions depending on femoral anatomy and patient-specific factors, and we encourage further investigation into optimal fixation strategies for patients with Dorr A femoral morphology.
Core Tip: This case highlights bilateral femoral stem fractures in a patient with Dorr A femoral morphology, raising concerns about the mechanical reliability of cemented fixation in such cases. Through successful management with cortical window osteotomy and uncemented distal fixation, we emphasize the importance of tailoring revision strategies to femoral anatomy. Our experience reinforces the need to reconsider implant selection in Dorr A femurs to prevent recurrent failure.
