We report the case of a 15-year-old boy brought to the emergency department after a bike accident, complaining of an isolated left hip pain. The X-rays showed an obturator hip dislocation treated by closed reduction under general anaesthesia, followed by 6 weeks of discharge. The follow-up MRI performed 6 weeks after the trauma showed an avascular femoral head necrosis, for which we performed multiple retrograde femoral head drilling, completed by the injection of autologue stem cells from the iliaq crest. One year later, the patient has no hip pain, no joint limitation, and can practice BMX at a high level again. The purpose of this report is to make the physicians aware of this rare problem that may be damaging for hip function, especially in young people.
Fractures in the elderly population are a major increasing issue for any healthcare institution, associated with the growing life expectancy. Proximal tibial fractures affect the metaphyseal bone with or without articular extension, in 5 to 11% of all tibia fracture. Treatment options such as plate fixation, intramedullary nailing or even primary total knee arthroplasty are accepted valuable options. However, specific age-related risk factors such as osteoporosis, arthritis, multiple comorbidities and soft-tissue impairment shall also be taken in consideration as they may lead to severe complications if not fully understood. Therefore, a hybrid tibio-tibial external fixator may be considered as a valid surgical option for primary and definitive treatment care of these fractures especially if associated with soft-tissue damage. We report a retrospective observational analysis of three cases of closed extra-articular proximal tibia fractures associated with soft-tissue impairment in a geriatric population and treated with a hybrid external fixator (TenXor, Stryker). The fractures were classified according to the AO, as metaphyseal fractures (AO 41A2.1, 41A3.3). The post-operative protocol was standardized, with immediate full weight bearing. Complete consolidation of the fractures was obtained at 6 months. There were no pin tract infection and removal of the material has been done at 6 months. No cut-out of the proximal tibial wires was observed. The primary and definitive care of proximal tibial fractures by a hybrid external fixator appears to be a valuable surgical option in geriatric patients especially when associated with poor soft tissue coverage. The major advantage of this technique, acknowledging the longer bone consolidation process, is to avoid additional insult to the soft tissues. This surgical option gathers further treatment perspectives in the elderly population especially in cases of soft tissue limitations.
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