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Non-union fracture neck femur in a young patient
a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 6 4 e6 5
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/apme
Interesting Rare Case Pictures
Non-union fracture neck femur in a young patient Raju Vaishya a,*, Vipul Vijay b, K.C. Kapil Mani b, Vikas Birla b a b
Prof, Department of Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, India Department of Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
1.
Case report
An 18-year-old boy fell 1 year ago from a tree and sustained right hip injury, which was treated by traction. At presentation, 15 years ago, he had pain, deformity and 300 shortening and was unable to bear weight on right leg. X-ray of the right hip showed non-union with resorption of neck of femur and proximal migration of femur (Fig. 1), but the head seemed viable. A corrective valgus osteotomy with the fixation of fracture was done using a Dynamic Hip Screw (DHS) with a 135 angle 4 hole plate. The patient did very well and both the osteotomy and fracture united without any avascular necrosis of the femoral head (Fig. 2). At 15 years follow up, the patient came for a routine implant removal (Fig. 3), when he was totally asymptomatic and has had only 1 cm of residual shortening of right hip and almost full range of hip movements. The implants were removed without any significant event (Fig. 4). Fracture neck of femur in young is rare and usually occur due to severe injuries like road traffic accident (RTA), fall from height etc. If the displaced fractures are not treated early then it is often associated with complications. Non-union is one of the commonest complications. Treatment of non-union of these fractures in young is quite challenging. An attempt to save the natural femoral head and hip joint is a priority and hence corrective valgus osteotomy with fixation of the fracture with stable implant is a good choice and may achieve union and preserve the natural hip joint, as it was in our case. Joint replacement may be a secondary choice but considering the young age of these patients, an attempt to fix the fracture along with a corrective osteotomy must be considered first, as it may preserve a natural hip joint.
Fig. 1 e Non-union of fracture neck femur with proximal migration of the trochanter.
* Corresponding author. E-mail address: [email protected] (R. Vaishya). 0976-0016/$ e see front matter Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved. http://dx.doi.org/10.1016/j.apme.2014.01.005
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Fig. 4 e X-ray showing hip joint, with united fracture after removal of implants.
2.
Fig. 2 e Early post op radiograph showing well fixed osteotomy and uniting fracture.
Learning points
Fracture neck of femur in children are rare injuries and are often caused by severe trauma Early surgical treatment is essential for better outcomes Neglected cases may need corrective osteotomy and fixation
3.
Image quiz
What is diagnosis of this condition? 1. 2. 3. 4.
Dislocation of the hip Fresh fracture neck of the femur Non-union of fracture neck of femur Dysplasia of the hip
Ans: Non-union of the fracture neck of femur with resorption of neck and proximal migration of the trochanter.
Fig. 3 e 15 year follow up X-ray showing well united and remodelled fracture with implants in situ.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/apme
Interesting Rare Case Pictures
Non-union fracture neck femur in a young patient Raju Vaishya a,*, Vipul Vijay b, K.C. Kapil Mani b, Vikas Birla b a b
Prof, Department of Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, India Department of Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
1.
Case report
An 18-year-old boy fell 1 year ago from a tree and sustained right hip injury, which was treated by traction. At presentation, 15 years ago, he had pain, deformity and 300 shortening and was unable to bear weight on right leg. X-ray of the right hip showed non-union with resorption of neck of femur and proximal migration of femur (Fig. 1), but the head seemed viable. A corrective valgus osteotomy with the fixation of fracture was done using a Dynamic Hip Screw (DHS) with a 135 angle 4 hole plate. The patient did very well and both the osteotomy and fracture united without any avascular necrosis of the femoral head (Fig. 2). At 15 years follow up, the patient came for a routine implant removal (Fig. 3), when he was totally asymptomatic and has had only 1 cm of residual shortening of right hip and almost full range of hip movements. The implants were removed without any significant event (Fig. 4). Fracture neck of femur in young is rare and usually occur due to severe injuries like road traffic accident (RTA), fall from height etc. If the displaced fractures are not treated early then it is often associated with complications. Non-union is one of the commonest complications. Treatment of non-union of these fractures in young is quite challenging. An attempt to save the natural femoral head and hip joint is a priority and hence corrective valgus osteotomy with fixation of the fracture with stable implant is a good choice and may achieve union and preserve the natural hip joint, as it was in our case. Joint replacement may be a secondary choice but considering the young age of these patients, an attempt to fix the fracture along with a corrective osteotomy must be considered first, as it may preserve a natural hip joint.
Fig. 1 e Non-union of fracture neck femur with proximal migration of the trochanter.
* Corresponding author. E-mail address: [email protected] (R. Vaishya). 0976-0016/$ e see front matter Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved. http://dx.doi.org/10.1016/j.apme.2014.01.005
a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 6 4 e6 5
65
Fig. 4 e X-ray showing hip joint, with united fracture after removal of implants.
2.
Fig. 2 e Early post op radiograph showing well fixed osteotomy and uniting fracture.
Learning points
Fracture neck of femur in children are rare injuries and are often caused by severe trauma Early surgical treatment is essential for better outcomes Neglected cases may need corrective osteotomy and fixation
3.
Image quiz
What is diagnosis of this condition? 1. 2. 3. 4.
Dislocation of the hip Fresh fracture neck of the femur Non-union of fracture neck of femur Dysplasia of the hip
Ans: Non-union of the fracture neck of femur with resorption of neck and proximal migration of the trochanter.
Fig. 3 e 15 year follow up X-ray showing well united and remodelled fracture with implants in situ.