Segmental Fractures of the Neck of Femur: Fix or Replace?

Biesemans, Stef; Vandesande, Wim

doi:10.1016/j.artd.2021.03.004

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Yoo et al attempted to classify this fracture and showed that 33 patients of a similar age and fracture type had an 85% bone union rate with a CMN (noting that every failed union correlated with an unsatisfactory reduction on the postoperative lateral plain film views) [ 3 ]. In addition to this case, there is evidence in the literature of successful treatment with arthroplasty [ 15 ].…”

Section: Discussionmentioning

confidence: 98%

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

Haese¹,

Delgadillo²,

Anderson³

et al. 2022

Cureus

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Peri-trochanteric fractures with an extension into the femoral neck are relatively rare. Due to the lack of a defined treatment in the literature, these fractures pose a challenge to orthopedic surgeons. This case report highlights the value of timing to surgical intervention, choosing the appropriate operative course, not treating very important person (VIP) patients differently than standard patients, and decreasing unnecessary costs for the patient and the US healthcare system.An 85-year-old male VIP patient presented to the emergency department (ED) with a left peri-trochanteric fracture with an extension into the ipsilateral femoral neck. The initial plan was to perform arthroplasty with diaphyseal fixation. However, the community-based hospital would have to wait two to three days for the proper implants, and the patient insisted on being treated at this hospital. Due to concerns about increased mortality with delayed treatment, the patient underwent short cephalomedullary nail (CMN) fixation the next day. On postoperative day (POD) 49, a pop was heard and felt while ambulating, and radiographs revealed substantial lateral cutout of the CMN and subsidence of the femoral head. On POD 54, the patient underwent a successful left total hip arthroplasty using a modular diaphyseal press-fit femoral component, which resulted in an uneventful recovery. This case illustrates a cautionary tale in choosing the appropriate operative course for a VIP patient with a peri-trochanteric fracture extending into the femoral neck (a relatively rare fracture type that has no clearly defined treatment option). This is imperative to reduce pain and length of stay for the patient, postoperative complications, and cost. Based on the results from the second procedure and weighing the risk of prolonged treatment, the authors believe that this patient would likely have benefited from a primary arthroplasty procedure given his body habitus and complex fracture pattern.

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Section: Discussionmentioning

confidence: 98%

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

Haese¹,

Delgadillo²,

Anderson³

et al. 2022

Cureus

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show abstract

“…The combined ipsilateral femoral neck and trochanter fracture is unusual. We performed a literature review and found 20 unique cases reported and a small retrospective study [1]. In most cases, this injury is due to a low energy trauma occurring in elderly osteoporotic patients.…”

Section: Discussionmentioning

confidence: 99%

“…A therapeutic option justified by the high degree of fracture site comminution and displacement of the femoral head, predicting the important risk of avascular necrosis and nonunion. Biesemans and vandesande treated a 42-year-old man using a primary cemented total hip arthroplasty combined with tension band cerclage and triple K-wire trochanteric fixation and reported satisfying functional results after one year follow up [1]. Khan et al reported three cases treated using hip arthroplasty and had also good results after two years follow-up [6].…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral Femoral Neck and Trochanter Fracture: A Case Report and Literature Review

Zeroual¹,

Zahraoui²,

Alaoui³

et al. 2022

JSCR

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Simultaneous ipsilateral femoral neck and trochanteric fracture is a rare injury. it occurs most commonly in elderly patients with low energy trauma. Its management present a significant challenge to the orthopaedic surgeons. We report the case of 77 years old male, who sustained simultaneous transcervical femoral neck and intertrochanteric fractures caused by an olive tree fall. The patient was treated with a standard gamma nail, with a satisfactory functional result at 3 months follow-up.

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“…Internal fixation (cephalomedullary nail and dynamic hip screw) in fixation of pertrochanteric fractures usually includes prolonged bed rest or limited ambulation, to avoid implant failure due to osteoporosis. This might lead to a higher chance of the development of complications like pulmonary embolism, deep vein thrombosis (DVT), lung infection (pneumonia), and bed sores (decubitus ulcer) (7) .…”

Section: Introductionmentioning

confidence: 99%

Management of Unstable Per-trochanteric Fracture in Old Patient by Primary Prosthetic Replacement

El-Azab

Yousef

Said

2022

SJMS

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Background: Peritrochanteric fractures are frequent of the proximal femur and represents about half of all proximal femur fractures. They are associated with disability, mainly in elder patients. Its management aiming to achieve immediate ambulation and to regain the pre-operative ambulation. Aim and objectives; to evaluate and assess the functional and radiological outcomes of primary prosthetic replacement in old age cases of unstable per-trochanteric femur fractures, Subjects and methods: The current work was an interrupted time series clinical trial (quasi experimental), included 15 patients suffering from unstable per-trochanteric fracture presented to us within a week of sustaining injury. They were clinically assessed and checked for fitness for surgery. Then and after surgery, they were followed by for functional outcome by Harris Hip Scale and any complications were recorded. Results: Patients age ranged between 61 and 94 years. Females were more affected than males (80.0% vs 20.0%). Associated comorbidities were hypertension, diabetes and both conditions among 33.3%, 6.7% and 33.3%, successively. Falling was the commonest mode of injury (60.0%), and the left side was more affected than the right (60.0% vs 40.0%). Associated injuries were 1(6.7%) fracture surgical neck hummers, 1(6.7%) contralateral both bone leg fracture, 1(6.7%) had fracture mid shaft ulna. Regarding outcome, all cases were free from postoperative complications. However, blood loss was reported among 11(73.3%). Twelve (80%) patients had an excellent, 2 (13.3%) had good and 1(6.7%) had fair functional outcome. There was significant association between functional outcome and patients, gender, associated comorbid medical conditions, mode of trauma, side of trauma, or blood loss. Conclusion: Primary prosthetic replacement is a valid surgical option in management of unstable trochanteric fractures in elderly. The main advantages are the safety, effectiveness and early full weight bearing.

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Segmental Fractures of the Neck of Femur: Fix or Replace?

Cited by 5 publications

References 28 publications

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report

Ipsilateral Femoral Neck and Trochanter Fracture: A Case Report and Literature Review

Management of Unstable Per-trochanteric Fracture in Old Patient by Primary Prosthetic Replacement

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