Role of postero-medial cortex in a pathological sub-trochanteric femur fracture in elderly: A case series

Abstract

To analyse the role of postero-medial cortex in a pathological sub-trochanteric femur fracture in elderly and evaluation for primary neoplasm. Methods: Six patients with pathological fractures of sub-trochanteric femur were included. The patients were over the age of sixty years comprised of both males and females. All the fractures were stabilized by internal fixation with intramedullary nailing and were followed post-operatively. The patients were evaluated for primary neoplasm by recording a clinical history, physical examination, routine laboratory investigations, plain radiography of the involved bone and the chest, whole-body technetium-99mphosphonate bone scintigraphy, and computed tomography of the chest, abdomen, and pelvis. Results: All the patients were mobilized by non-weight bearing mobilization with walker support postoperatively and were allowed complete weight bearing mobilisation depending on the progress and fracture healing pattern. Primary neoplasm was identified in all of these cases. Chemotherapy was continued. In four patients, fracture united at twelve weeks with fixation and chemotherapy. One patient died during the post-operative period diagnosed with plasmacytoma. Fracture did not unite in one patient who stopped chemotherapy in the post-operative period and had metastasis of the tumour. Conclusion:Fractures in the elderly patients with trivial fall or postero-medial cortex deficit should be carefully evaluated for pathological fractures. Internal fixation with intramedullary nail can be a mainstay of treatment for such pathological fractures. Further evaluation of the primary tumour should be undertaken in all such cases.