Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report

Abstract

IntroductionThe avascular necrosis of the femoral head represents the death of bone tissue due to the lack of blood supply. The disease has a progressive evolution and left untreated leads to femoral head collapse and severe arthritis.Case presentationWe present a case of a pertrochanteric fracture which has been successfully operated with a dynamic interlocking trochanteric gamma nail on the right hip. At 2 years after surgery the patient developed an incipient avascular necrosis of the femoral head. Despite the good positioning of the implant, we considered that the source of the pain was an intolerance of the implant, and thus we removed it. After implant removal, the patient was kept under observation and conservative treatment, to prevent further damage to the right hip and allow the healing to occur. At 6 months after the gamma nail was removed the X-rays revealed advanced avascular necrosis of the femoral head and secondary osteoarthritis on the right hip. The patient underwent surgery with an uncemented total hip arthroplasty.DiscussionThere are a few discussions regarding the avascular necrosis of the femoral head. These discussions may include the predisposing risk factors, the treatment of choice and the postoperative complications.ConclusionThe avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

The relationship between femoral neck fracture in adult and avascular necrosis and nonunion: A retrospective study

“…Some surgeons, however, prefer ORIF and some prefer THA for displaced FNFs, particularly among active older patients with Garden Type III fracture [ 16 ]. A case of peritrochanteric fracture was also reported to be successfully operated with a dynamic interlocking trochanteric gamma nail [ 17 ].…”

Femoral Head Avascular necrosis following intramedullary Gamma-nailing: A rare complication

“…it arises when blood supply to the bone is interrupted 2 . This can be either due to a macroscopic damage to vessels as in the case of trauma/fracture or due to microscopic vascular changes that can be attributed to autoimmune disorders, metabolic diseases, use of steroids while it can also be idiopathic in origin [2][3][4][5] . By the time clinical symptoms are noticed by patients the damage to the bone Once suspected AVN can be diagnosed by plain X-rays or Magnetic Resonance Imaging 2 .…”

“…This is a quite rare complication reported at a 0.5% occurrence due to the fact that neither the mechanism/location of the fracture nor its fixation are known to affect nourishment of the femoral head from its three main supplying arteries (nutrient artery of the shaft; retinacular/capsular arteries; artery of the round ligament of femur/foveolar) 7,8 . A Total Hip Replacement which is the most advisable treatment in such cases as per many authors was performed [5][6][7] . The result was successful and the patient regained the full function of her limb.…”

“…It is a pathological state associated with the reduction of vascular supply to the subchondral bone of the femoral head leading to osteocyte death and the inevitable collapse of the affected femoral head 2 . Predisposing factors include but are not limited to fracture, steroids, alcohol abuse, metabolic disorders and haemoglobinopathies [2][3][4][5] . Initially, the disease is clinically silent therefore at presentation destruction of the bone is often substantial 2 .…”

Некоторые Вопросы Асептического Некроза Головки Бедренной Кости

“…Природа змін, що виникають в головці стегнової кістки, до кінця не вивчена, але безсумнівною залишається травматична етіологія захворювання. На думку С. Delaunay, залежно від тяжкості травми у 10-50 % хворих з різними ушкодженнями ділянки кульшового суглоба (КС) в найближчі або віддалені терміни розвивається асептичний некроз [7]. Низка зарубіжних авторів, вивчивши сучасні методи хірургічного лікування при переломах і їх віддалені наслідки, вважають, що впливають на розвиток АНГСК вік пацієнта і відстрочка операції, але не спосіб лікування [38].…”