Proximal Femoral Fracture in Hip Arthrodesis Treated with Double Reconstruction Plates

Abstract

We present a rare clinical case of a 90-year-old female who sustained a proximal femoral neck fracture following long-standing hip arthrodesis. Since the fracture occurred relatively proximally and involved the pelvis, double-plate fixation was chosen to achieve rigid fixation. The reconstruction plate was placed at the posterior and anterior columns individually through single vertical incision. She was treated successfully, and she attained preinjury activity level. Proximal femoral fractures in arthrodesed hips need to be recognized as a fracture between the pelvis and femur. Rotational stress from the trunk and lower extremity requires rigid fixation to minimize the increase of displacement and the risk for nonunion.

Total Hip Arthroplasty for Femoral Neck Fracture after Postoperative Intertrochanteric Fracture in a Patient with Spontaneous Fused Hip

“…There are a few available reports regarding proximal femoral fractures in arthrodesis or spontaneous fused hip joints [10][11][12][13][14][15][16][17][18][19][20]. Sponseler et al reported in 1984 that the rate of proximal femoral fracture in this condition was 73% (2/53 cases) [9].…”

“…The fractured fragment was divided into two fragments, which consisted of the pelvis with proximal femur as the proximal fragments and the distal femur with the long lever arm of the lower extremity as the distal fragment. The large rotational stress and the shear stress were produced at the fracture site until bony fusion was performed [11,20]. Therefore, it was difficult to maintain sufficient stability with conservative treatment to achieve bony fusion; thus, there have been no reports that recommend conservative treatment.…”

“…ORIF cannot be expected to improve the leg length discrepancy and acquisition of a hip range of motion; however, if the bony fusion is obtained, the patient may be able to acquire the same ADL from before the fracture. Most of the previous reports on treatments with ORIF were related to intertrochanteric fracture or subtrochanteric fracture, and successful results with various methods and implants for osteosynthesis have been reported [12,15,16,19,20]. However, it is necessary to maintain a very rigid fixation on the fracture site.…”

“…On the other hand, a proximal femoral fracture in a patient with a fused hip rarely develops [9]. Previously, various successful procedures for osteosynthesis have been reported [10][11][12][13][14][15][16][17][18][19][20], and patients were able to acquire the same level of activities of daily living (ADL) as before the fracture. To the best of our knowledge, there have been no reports that describe one-stage THA for a patient with a proximal femoral fracture under a long-standing fused hip.…”