Open Reduction and Internal Fixation of a Proximal Femoral Shaft Fracture in a Patient with Bilateral Congenital Hip Disease

We present a rare case of a femoral shaft fracture in a 74-year-old woman with a preexisting untreated bilateral congenital hip dislocation and with concomitant leg length discrepancy. Because of the marked deformity of the upper femur, a derivative of the congenital hip disease, an open reduction and internal fixation was performed, with the use of an anatomic femur plate originally designed for the treatment of periprosthetic fractures. The patient was treated successfully and returned to her previous status of activity. The management of a femoral fracture in the presence of ipsilateral hip disease is a challenging issue. The surgical treatment choice in such cases has to be individualized, taking into consideration several anatomic and medical parameters.

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Low-Energy Traumatic Obturator Hip Dislocation with Ipsilateral Femoral Shaft Fracture in a Patient with Omolateral Knee Arthroplasty

Case Reports in Orthopedics ◽

10.1155/2016/8754893 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

G. Gazzotti ◽

L. Patrizio ◽

S. Dall’Aglio ◽

E. Sabetta

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Femoral Shaft Fracture ◽

Hip Dislocation ◽

Femoral Shaft ◽

Shaft Fracture ◽

Low Energy ◽

Knee Prostheses ◽

Older Woman ◽

Great Awareness

Ipsilateral obturator hip dislocation and femoral shaft fracture are rare. We report such a case in an older woman after a low-energy injury. She had a knee prostheses in the same limb. The patient was treated by open manipulative reduction of the luxation without opening joint and open reduction and internal fixation of the femur with angular stability plate and screws. We could not find a similar case in the literature. An early diagnosis of the dislocation is crucial in order to obtain good results. Great awareness and radiologic examination are fundamental to achieve precocious diagnosis of both these rare combined injuries, as treatment in these cases is considered an emergency. The first step was an attempt to reduce the dislocation by closed means but it failed. Then we performed a short approach at the trochanteric region and used Lambotte forceps to manoeuvre the proximal femur without opening the joint achieving reduction. Thereafter the femoral shaft fracture underwent open reduction and internal fixation with an angular stable plate. After a 2-year follow-up the outcome was very good.

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Bifocal Bone Transport over a Preexisting Nail to Treat a Septic Femoral Shaft Nonunion

Case Reports in Orthopedic Research ◽

10.1159/000501844 ◽

2019 ◽

Vol 2 (1-3) ◽

pp. 40-46

Author(s):

Haridimos Tsibidakis ◽

Francesco Guerreschi ◽

Fakher Fakhry ◽

Piero Poli ◽

Luca Grion ◽

...

Keyword(s):

Bone Healing ◽

External Fixator ◽

Intramedullary Nail ◽

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Bone Transport ◽

Leg Length ◽

Femoral Shaft Fractures ◽

Circular External Fixator

Intramedullary nailing is the method of choice for the treatment of most femoral shaft fractures. However, it is not always an easy procedure with predictable results as leg length discrepancy as well as rotational and angular malunion may occur. Lengthening over an intramedullary nail (IMN) has become very common as it allows early removal of the external fixator. This report presents a case of an open femoral shaft fracture initially treated with an IMN and subsequently complicated by a septic nonunion. Union was obtained by bifocal bone transport with a circular external fixator over the preexisting nail without exchange or removal of the previously inserted IMN. In conclusion, the presence of an IMN supports osteotomy and regenerates bone during bone healing, prevents fracture and/or deformation of the regenerated bone, and reduces the time needed for the external fixator.

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