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

Abstract

Avascular necrosis of the femoral head affects many patients annually. It results from reduced blood supply and can lead to complete loss of joint. The development of such a complication after certain types of hip trauma such as neck of femur fractures is not uncommon; nevertheless, extra-capsular fractures such as intertrochanteric ones are not a frequent cause of this complication reported at 0.5%. This case report presents the case of a 76 year-old woman who developed femoral head avascular necrosis following the fixation of her intertrochanteric fracture by an intramedullary Gamma nail. The early post-operative period suggestive of full recovery was followed by newlydeveloped symptoms of pain and reduced mobility. The removal of implants only partially alleviated symptoms while avascular necrosis was noted afterwards and was treated by a Total Hip Replacement before progression to involve the acetabulum. What is significant to stress in this case is the rarity of this complication arising after the specific trauma and operative technique. The anatomical location of the fracture does not advocate for a disruption in the femoral head's perfusion, neither does the fixation by an intramedullary approach. Nevertheless physicians should always be aware of such cases and investigate all patients with post-operative pain and/or reduced range of motion for avascular necrosis, as early recognition is essential.