Periprosthetic proximal and pertrochanteric femur fractures around a well fixed hip resurfacing implant present a challenge to orthopaedic surgeons, as they do not allow the most biomechanically favorable fixation constructs in patients with otherwise highdemand levels of physical activity. A 65-year-old man hit a tree while skiing. He presented to our emergency department with a right-sided pertrochanteric fracture of the proximal femur beneath an implant used in prior hip resurfacing. The patient underwent open reduction and internal fixation with intraoperative fluoroscopyassisted manipulation to ensure fixation of the hip resurfacing. At 6-week follow-up, a slight varus collapse at the fracture was noted. We continued to monitor our patient and the fracture healed with no further complications. Proximal femur fractures distal to a hip resurfacing may progress to mild varus collapse with promising outcomes after 5 months.

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