Review ArticleDiagnosis and Management of Intraoperative Fractures in Primary Total Hip ArthroplastySiddiqi, Ahmed DO, MBA; Springer, Bryan D. MD; Chen, Antonia F. MD, MBA; Piuzzi, Nicolas S. MDAuthor Information From the Department of Orthopedics, Cleveland Clinic Foundation, Cleveland, OH (Siddiqi, Piuzzi), the Department of Orthopedics Atrium, OrthoCarolina Hip and Knee Center, Musculoskeletal Institute, Charlotte, NC (Springer), and the Department of Orthopedics, Brigham and Women's Hospital, Boston, MA (Chen). Siddiqi or an immediate family member serves as an unpaid consultant to AZ Solutions, LLC; has stock or stock options held in ROMTech and serves as a paid consultant to Zimmer-Biomet. Piuzzi or an immediate family member serves as a board member, owner, officer, or committee member of ISCT; serves as a board member, owner, officer, or committee member of Journal of Knee Surgery, Journal of Hip Surgery and Orthopaedic Research Society. Piuzzi or an immediate family member has received research or institutional support from RegenLab and Zimmer-Biomet. Springer serves as a board member, owner, officer, or committee member of Knee Society, AJRR, AAHKS, Arthroplasty Today and Journal of Arthroplasty; paid consultant for Ceramtec, Convatec, Joint purifications systems, osteoremedies; receives royalties from Stryker. Chen serves as a board member, owner, officer, or committee member of AAOS, AJRR, AAHKS, Annals of Joint, CORR, European Knee Association, Healthcare Transformation ICJR, JOA, JBJI, JBJS, JOR, KSSTA, MSIS; has received royalties and paid consultant from AMA, Convatec, Ethicon, GLG, Graftworx, Guidepoint, Heraeus, Hyalex, Irrimax, Joint Purification System, Pfizer, PhagoMed, Recro, SLACK incorportated, Sonoran, Stryker, UpToDate. Journal of the American Academy of Orthopaedic Surgeons: January 20, 2021 - Volume Publish Ahead of Print - Issue - 10.5435/JAAOS-D-20-00818 doi: 10.5435/JAAOS-D-20-00818 Metrics Abstract Intraoperative periprosthetic fractures are challenging complications that may affect implant stability and survivorship. Periprosthetic acetabular fractures are uncommon and infrequently are the focus of studies. Acetabular fractures are occasionally recognized after patients report unremitting groin pain weeks postoperatively. The widespread use of cementless acetabular cups might lead to higher number of fractures than is clinically detectable. Conversely, the incidence of intraoperative periprosthetic femoral fractures are more common and encompass a broad spectrum, ranging from a small cortical perforation to displaced fractures with an unstable prosthesis. Appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of acetabular and femoral complications. This comprehensive review article focuses on the incidence, patient and surgical risk factors, diagnosis, management, and clinical outcomes associated with intraoperative acetabular and femur fractures in primary total hip arthroplasty. Copyright 2021 by the American Academy of Orthopaedic Surgeons.