Management Outcome of an Open Intertrochanteric with Associated Neck of Femur Fracture: A Rare Case Series

Abstract

Abstract Introduction: Intertrochanteric hip fractures are rare in young adults due to numerous soft tissue around the bone in the proximal femur. These fractures present a significant challenge for orthopedic surgeons in managing soft tissues, fracture reduction, fixation, and maximizing functional outcomes. Treatment of such injuries aims to prevent infection and achieve stable fixation and fracture union while reducing pain. Objective: This paper aims to present the series of open proximal femur fractures successfully managed with delayed intramedullary fixation, with a satisfactory functional and radiological outcome. Materials and Methods: Patients with an open proximal femoral fracture from Jan 2021 to Jan 2023 were evaluated retrospectively. Primary debridement was done at the earliest, and once the wound healed around 10–14 days later, definitive internal fixation by cephalo-medullary nailing was done. Patients were followed regularly at monthly intervals for 3 months, then every third month till the last follow-up at the end of 1 year to assess functional and radiological outcomes. Results: Three male patients with a mean age of 36 years with AO type 31A2.3 fracture were presented at a mean duration of 4 h, where primary debridement was done at a mean interval of 3.67 h from presentation, and the mean duration of definitive fixation was noted to be 12 days. Fracture union was noted at a mean interval of 26 weeks. There was no evidence of osteonecrosis of the femoral head after union. At the final follow-up, all patients had a VAS of 2/10 and a mean HHS of 82.6. Conclusion: In open intertrochanteric with the neck of femur fractures, delayed cephalomedullary fixation after aggressive primary debridement and after soft tissue recovery helps to decrease the risk of infection and provides the advantage of early mobilization and favorable functional and radiological outcomes.