Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur: a case report

Abstract

IntroductionWe report the case of an unusual combination of concomitant subcapital and intertrochanteric fractures of the hip in a patient after a motorcycle accident. To the best of our knowledge, there is no previous report in the literature of these conditions as a result of high energy trauma or of the treatment used.Case presentationA 36-year-old Caucasian man was admitted with this rare fracture combination, and was managed with closed fracture reduction and fixation with a dynamic hip screw combined with an anti-rotational cannulated screw. We found four similar cases on reviewing the literature from 1989 to 2009, but these were reports of older patients after low energy injury.ConclusionWe found that segmental fracture of the femoral neck region is an extremely rare and uncategorized hip injury that can occur not only in older people but also in young non-osteoporotic patients, and should be considered for inclusion in femoral fracture classification systems.

A retrospective cohort study of concomitant ipsilateral extra-capsular and intra-capsular fractures of the proximal femur. Are they casual findings or an undervalued reality?

“…In almost every case the two fracture lines seem to be independent of each other, indicating a different injury mechanism from that of isolated subcapital or intertrochanteric fracture. As George Loupasis posited in his case report [13], our hypothesis concerning the fracture mechanism points to a sequential model, it is likely that the subcapital fracture occurs first when the femoral neck impinges against the acetabulum as a result of an excessive flexion/external rotatory force to the hip. At this stage, if those forces have still not dissipated, a fracture in the trochanteric region may occur.…”

“…Full preservation of the femoral head should be the main goal in the treatment of this complex injury in younger patients [13]. In old and frail patients the therapeutic choice should rely on different aspects, related to bone quality, fracture pattern, comorbidities, ability to walk prior to the fall and also in surgeon skill and preferences.…”

“…The combination of both fracture patterns in elderly patient is considered to be very rare and scientific references are extremely scarce, with most references appearing as case reports [6][7][8][9][10][11][12][13][14][15]. To our knowledge, the association of both fractures in osteoporotic bone, as a result of low energy trauma, was described thirty years ago in a case report [6,7], and the only series (29 cases of extra-capsular fractures associated with femoral neck fracture) of these rare fractures in proximal femur was drawn up a decade ago [16], reporting an incidence of 7.5% (29 out of 385).…”

Ipsilateral femoral neck and trochanter fracture

“…The presence of an ipsilateral fracture neck of femur (NOF) and trochanter is rare and seen in elderly osteoporotic patients due to low energy injuries. However, the occurrence of such injuries in young patients due to high energy injury is also published in the literature 23…”

“…However, the occurrence of such injuries in young patients due to high energy injury is also published in the literature. 2 3 …”