Successful Treatment of Concomitant Ipsilateral Intracapsular and Extracapsular Hip Fractures

Abstract

Femoral neck fractures and intertrochanteric fractures often occur in elderly patients, but simultaneous ipsilateral intra- and extracapsular hip fractures are rare. Either osteosynthesis or femoral head prosthesis is performed, but careful rehabilitation is necessary because of the instability of the fracture, even postoperatively. This article describes a 76-year-old man who fell and sustained concomitant ipsilateral intra- and extracapsular hip fractures. The patient was treated with a femoral head prosthesis with a polished cemented stem combined with locking plate osteosynthesis. Weight-bearing gait was possible 1 day postoperatively, and bone union was achieved at postoperative week 8. The locking plate had excellent angular stability, even when the screw fixation was monocortical, leading to a reduced risk of intraoperative redislocation without disturbing stem insertion. Sufficient fixation was obtained as a result of the molding effect of the cement stem and the tension band function of the plate. These effects collectively made it possible to achieve full weight-bearing gait immediately postoperatively. Although the intramedullary blood circulation was disturbed by the cement, periosteal blood circulation was retained by the virtue of the locking plate, which facilitated early bone union.

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 our cohort, as we are a trauma team, we have, in over two thirds of the cases, chosen internal fixation, both intramedullar or extramedullar devices. Yet a skilled hip team would probably have chosen hip arthroplasty, possibly with similar clinical results [15].…”

“…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).…”

Case report: AVN of the femoral head five year follow-up of the combination of ipsilateral femoral neck and sub-trochanteric fracture

“…There are 13 reports in the medical literature of ipsilateral fractures of the femoral neck and trochanteric region [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] . Of these, nine cases are reported in elderly osteoporotic patients following low energy fall [1] , [2] , [3] , [4] , [5] , [6] , [7] , [9] , [11] . One case was of a 54-year-old person caught in olive press [8] and the others were of patients with a motor vehicle accident [10] , [12] , [13] .…”

Benefit of lag screw placement by a single- or two-screw nailing system in elderly patients with AO/OTA 31-A2 trochanteric fractures

“…5,6 If the patient's condition allows, treatment should be performed as soon as possible to prevent complications. 7,8 Surgery is the preferred treatment method for trochanteric fractures because it reduces the risk of complications within the shortest time possible. 9 Internal fixation can be performed using an extramedullary or intramedullary system; of these, intramedullary systems have many advantages and are widely used in the treatment of trochanteric fractures.…”