Rationale:
Pediatric femoral shaft combined with ipsilateral femoral neck fractures are very rare but challenging injuries fraught with the development of avascular necrosis, coxa vara, and leg length discrepancy. Majority of the previous reports indicated the neck femur fracture was fixed with cannulated screws or/and pins, femoral shaft fracture was stabilized with a plate and screws. However, we used cannulated screws combined with elastic stable intramedullary nails to minimally invasive procedures treat this type of injury and achieved good follow-up results.
Patient concerns:
A 7-year-old boy (Case 1) was hospitalized due to a traffic accident resulting in swelling and deformity of the right thigh accompanied by limited mobility of hip and knee. A 5-year-old male child (Case 2) presented with pain and swelling in the bilateral lower limb after fall from approximately 12 feet.
Diagnoses:
Physical examination, X-ray film, and computed tomography were performed. Both patients were diagnosed with ipsilateral femoral neck and shaft fracture.
Interventions:
The fractures were reduced closed by image-intensifier imaging. Two partially threaded cancellous screws were used to fix femoral neck fracture, and elastic intramedullary nails were performed to stable the femoral shaft fracture. Postoperatively, the patients were immobilized in a one-and-a-half hip spica cast for six weeks. The internal fixations were removed after one year.
Outcomes:
Case one was follow-up at 14 months and the other one was followed up for 3 years. And at the last follow-up showed a normal and painless hip function. No clinical complications were found during follow-up visit, including head penetration, implant failure, fracture nonunion, avascular necrosis and hip varus deformity.
Lessons:
Clinician should carefully check and read relevant imaging data to avoid missed diagnosis. And the internal fixation method described in this paper may be more minimally invasive.
BackgroundIntrathoracic displacement of a humeral head fracture is extremely rare.Only slightly more than 30 cases have been reported. Because few cases have been reported, there is no consensus on how to treat this injury. The etiology, injury mechanism, related lesions and treatment of the injury are diverse.Case presentationA 73-year-old woman presented with multiple fractures of the left ribs, bilateral lung contusions, extensive emphysema of the anterior and posterior chest wall, massive left hemopneumothorax, fracture-dislocation of the proximal humerus and intrathoracic displacement of the humeral head.The patient was sent to the operating room for emergency thoracotomy surgery. The head of the humerus was confirmed to be completely removed from the thoracic cavity during the operation. After discussion with the orthopedic surgeon, the humeral head was discarded considering avascular necrosis, and open reduction and internal fixation were not performed.Three weeks later, the orthopedic surgery team performed reverse shoulder arthroplasty.During follow-up, the patient’s shoulder was free from pain, and its range of movement (ROM) included 110° flexion, 70° abduction, 35° external rotation and 50° internal rotation.ConclusionsIntrathoracic displacement of the humeral head due to proximal humeral fracture is a very rare and serious trauma that requires multidisciplinary treatment. Considering the extremely high risk of humeral head necrosis, actively removing broken bone fragments of the humeral head in the early stage is recommended, and we advocate for shoulder arthroplasty for elderly patients. Detailed preoperative evaluations and individualized operation plans should be made to achieve the best effect.
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