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Rationale: Currently, there are no clear guidelines to determine whether and when to perform surgical hip repair in patients with acute stroke and hip fracture.Patient concerns: In this case report, we report a case of 75-year-old woman admitted with left hip pain and limited mobility for 1 month.Diagnoses: Patient had a history of acute cerebral infarction 42 days ago, and diagnosed with a left intertrochanteric fracture at another hospital 30 days ago.Intervention: Patient was treated with closed reduction and internal fixation with proximal femoral nail anti-rotation.Outcomes: At 2-year follow-up, the patient's basic function was restored. The fracture healed well, and the Harris hip score was 75.Lessons: Without consistent guidelines, individualized treatment strategies including surgical methods and timing of surgery should be made to weigh the risks and benefits for patients with acute stroke and intertrochanteric fractures.Abbreviations: CRIF = closed reduction and internal fixation, PFNA = proximal femoral nail anti-rotation.

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Background The commonly used technique for treating unstable pelvic fractures with sacroiliac screws and anterior internal fixator (INFIX) is prone to complications, such as injury to the pelvic vasculature and nerves, life-threatening bleeding, lateral femoral cutaneous neuritis, and wound infection. This study investigated the clinical effects of using a modified percutaneous iliosacral screw and INFIX technique for treating unstable pelvic fractures. Methods A retrospective analysis of minimally invasive internal fixation using modified incision of an anterior-ring INFIX application combined with modified percutaneous iliosacral screw placement was performed for 22 cases of unstable pelvic fractures from January 2017 to December 2018. Based on the Tile classification, there were 4 type B1, 7 type B2, 5 type B3 and 6 type C1 injuries. Preoperatively, the length and orientation of the internal fixation were computer-simulated and measured. On postoperative day 3, pelvic radiographs and three-dimensional computed tomograms were used to assess fracture reduction and fixation. All patients were regularly followed up at 4 weeks, 12 weeks, 6 months, 12 months, 24 months and annually thereafter. Fracture healing, complications, visual analogue scale (VAS) scores, the quality of fracture repositioning and Majeed score were assessed during follow-up. Results All patients were followed up for a mean of 25.23 ± 1.48 months. All fractures healed without loss of reduction and no patient showed evidence of delayed union or nonunion. Two years postoperatively, the mean VAS score was 0.32 ± 0.09 and the mean Majeed score was 94.32 ± 1.86. Conclusion The modified percutaneous iliosacral screw technique increases the anterior tilt of the sacroiliac screw by shifting the entry point posteriorly to increase the safety of the screw placement. Downward modification of the INFIX incision reduces the risk of lateral femoral cutaneous nerve injury. This technique is safe, effective and well tolerated by patients.