Combined Intracapsular And Extracapsular Neck Of Femur Fractures Case Series, Literature Review And Management Recommendations

Wasim Khan,Sam Hopwood,Rhodri Williams,Sanjeev Agarwal

doi:10.2174/1874325001711010600

Abstract

Concomitant ipsilateral intracapsular and extracapsular fractures of the femoral neck are rare injuries with only 14 cases described in the literature as single case reports. We present three cases that were successfully and uniquely treated by uncemented hip arthroplasties. Two patients underwent complex primary uncemented total hip replacements, and one patient underwent an uncemented bipolar fluted stem hemiarthroplasty. The level of bearing constraint varied between implants. After describing our cases we review the literature and make recommendations on the management of these injuries. We believe that these are significant injuries and best functional results can be achieved with an early diagnosis and patient-specific approach that can include a total hip replacement in appropriate cases.

Highlights

Concomitant ipsilateral intracapsular and extracapsular fractures of the femoral neck, otherwise known as segmental neck of femur fractures, are rare injuries but are difficult to manage. These are generally associated with either significant trauma in young patients or low energy injuries to pathological bone in older patients. These injuries are associated with a significant risk of complications including avascular necrosis, non-union and malunion, potentially greater than those associated with single fractures
There has been a limited number of single case reports described in the literature where these fractures are managed with internal fixation or hemiarthroplasty
We present three cases with segmental neck of femur fractures successfully managed with total hip replacements and a hemiarthroplasty

Summary

INTRODUCTION

Concomitant ipsilateral intracapsular and extracapsular fractures of the femoral neck, otherwise known as segmental neck of femur fractures, are rare injuries but are difficult to manage. Case 1: A 66 year old male sustained a low energy fall He was a residential home resident with a history of previous alcoholism and cognitive impairment. The complicating factors were the patient’s cognitive impairment and abductor insufficiency secondary to the trochanteric fracture To address these factors, the patient underwent a complex primary total hip replacement with a constrained liner and trochanteric grip plate (Fig. 1b). Due to the segmental nature of the fracture and the pre-existing severe arthritis, fixation was not considered a valid option, and the patient underwent a total hip replacement with plate stabilisation for the fracture extension (Fig. 2b). Case 3: Our third case was an 80 year old nursing home resident with multiple co-morbidities who mobilized with a Zimmer frame She had a fall and radiographs revealed an intracapsular fracture with concominant subtrochanteric fracture with diaphyseal extension (Fig. 3a).

LITERATURE REVIEW

86 F Fall at home

DISCUSSION

CONCLUSION