{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:55:12Z","timestamp":1791201312716,"version":"4.2.0"},"reference-count":29,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objective: Intraoperative femoral fractures during cementless hemiarthroplasty may present with distinct anatomical patterns. We examined whether surgical approach was associated with greater trochanteric versus stem-stable periprosthetic fracture patterns in older patients with osteoporotic-type femoral morphology; stem geometry was evaluated as an additional implant-related factor. Methods: We retrospectively reviewed 292 patients aged \u226575 years who underwent cementless bipolar hemiarthroplasty for low-energy displaced femoral neck fractures at a tertiary referral trauma center between January 2019 and July 2023. Patients were grouped according to stem geometry (fit-and-fill or tapered-wedge) and surgical approach (lateral or posterior). Associations were assessed using multivariable logistic regression, Firth-penalized regression, and stabilized inverse probability of treatment weighting (IPTW). Results: Intraoperative fractures occurred more frequently with the lateral approach than with the posterior approach (23.7% vs. 12.2%; p = 0.015), primarily because of greater trochanteric fractures (9.5% vs. 2.4%; p = 0.016). Periprosthetic fracture rates did not differ significantly between the approaches (14.2% vs. 9.8%; p = 0.284). In the Firth model, the posterior approach was associated with lower odds of greater trochanteric fracture (OR 0.25, 95% CI 0.08\u20130.80; p = 0.019); after IPTW, the corresponding estimate was OR 0.19 (95% CI 0.05\u20130.76; p = 0.019). Conclusions: The surgical approach was primarily associated with greater trochanteric fractures, whereas no independent association was observed with stem geometry. Pattern-specific analysis may provide a clearer characterization of intraoperative fracture associations in this setting.<\/jats:p>","DOI":"10.3390\/jcm15197666","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:57:46Z","timestamp":1791197866000},"page":"7666","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Surgical Approach with Intraoperative Femoral Fracture Patterns During Cementless Hemiarthroplasty for Femoral Neck Fracture"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3535-4100","authenticated-orcid":false,"given":"Ali","family":"Tecirli","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Ankara D\u0131\u015fkap\u0131 Training and Research Hospital, Ankara 06110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Seyyid Serif","family":"Unsal","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Ankara Atat\u00fcrk Sanatorium Training and Research Hospital, Ankara 06290, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Tugrul","family":"Yildirim","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Yuksek Ihtisas University, Ankara 06530, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Alp","family":"Karacoban","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Mardin Training and Research Hospital, Mardin 47100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1297","DOI":"10.5435\/JAAOS-D-22-00273","article-title":"AAOS Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline","volume":"30","author":"Switzer","year":"2022","journal-title":"J. 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