Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Feb 01, 2014 recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Proximal femoral fractures rsna publications online. Isolated apophyseal avulsion of the greater trochanter. Several trochanteric fracture classifications exisi1. Management of pipkin fractures using a safe surgical hip.
Surgical treatment of basicervical intertrochanteric. Surgical treatment of basicervical intertrochanteric fractures of the. Figure 2 emergency xray of her right hip showing a simple intertrochanteric fracture associated with femoral head stage vi avascular necrosis, with the femoral head impacted in the acetabular rim. There were no cases of avascular necrosis avn at the end of the followup period of 1 year. In young patients, they are typically an avulsion fracture caused by forceful contraction of the gluteus medius and minimus in the case of the greater trochanter and the iliopsoas in the case of the lesser. A hip fracture is a break that occurs in the upper part of the femur.
O ccurrence of simultaneous ipsilateral fracture of the femoral neck and trochanteric region is rare. Avascular necrosis avn of the femoral head is a relatively uncommon complication following an extracapsular hip fracture. Typically, isolated greater trochanteric fractures can be treated nonoperatively. Hence, it is clear that femoral head fracture dislocation is a rare condition, and dislocations that cannot be reduced by the close method is even rarer. Introduction unstable trochanteric fractures continue to be a challenge for orthopedic surgeons. The distribution of the fractures in our series is included in table 1. Avascular necrosis of the head as sequela offracture the greater trochanter. Ap radiographic reveal a ipsilateral left femoral neck and sub trochanteric fracture. Greater trochanteric pain syndrome clinical practice guideline disclaimer this guideline is intended as an aid for clinicians treating patients diagnosed with greater trochanteric pain syndrome, utilizing an evidencebased load management treatment strategy. A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur. Avascular necrosis of the femoral head following inter trochanteric fractures. A comparison of dynamic hip screw and two cannulated.
Treatment of femoral neck fractures with a sliding compression screw femug two knowles pins. Hip fractures including neck and peritrochanteric regions. The most common cause is highenergy road traffic accidents with associated injuries of the ipsilateral knee, acetabulum, femoral neck, sciatic nerve, and pelvis. The question of which surgical approach would be the better one to treat femoral head fracture and its relationship with ho and avn was controversial in the. To specifically observe for any sign of avn, patients undergoing fixation of acetabular fracture with trochanteric flip osteotomy were further followed up till the end of 2 years. Suggested risk factors included highenergy trauma with fracture comminution and displacement, and an atypical course of the fracture line, more proximal, at the. Patient was discharged on day 5 with strict bed rest for 6 weeks. Use of sliding hip screw in unstable trochanteric fractures is associated with signi. Fractures of the proximal femur in children often lead to complications in fracture healing caused by avascular necrosis avn of the femoral head. Full weight bearing, harris score of hip joint, complication. Professor of radiology thomas jefferson university hospital philadelphia, pa usa bursitis greater trochanteric bursitis lateral fluid common.
The various types of adult proximal femoral fractures require different treatment strategies that depend on a variety of considerations. Causes of hip pain less common things avascular necrosis. Regardless of the preference of using a short nail or a long nail, a large percentage of the hip fractures encompass basilar neck, intertrochanteric or subtrochanteric with minimal shaft extension. Fractures were fixed by pfn with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Suboptimal treatment of hip fractures may result in debilitating complications such as avascular necrosis. Femur specific plate designs combined with the polyaxial ncb locking plate technology offer solutions for fixation of particularly complex periprosthetic fractures.
Avascular necrosis of the femoral head as sequela of fracture of the greater trochanter. Twenty nine males and twenty four females were enrolled for the study. Zizic et al in a series of28 patients with systemic lupus erythematosus with avascular necrosis of multiple joints described the presenting complaints as pain on weight bearing or active motion in 77%, and pain at rest in 55%. Although several major risk factors for anfh have been proposed, most of them remain under discussion. Avascular necrosis avn of the femoral head is a progressive disease affecting young adults that results in collapse of the femoral head and subsequent degenerative joint disease. Postoperative infection, however, is a potentially serious compilation. Transcervical femoral fractures in young adults longdom.
Fracture of the greater trochanter rarely occurs after thr surgery without osteotomy 3. These fractures do have different characteristics, compared with the intertrochanteric fractures described in. Summary femoral neck fracture puts at risk functional prognosis in. Twelve patients between the ages of fiftynine and eightyeight who had developed avascular necrosis of the femoral head after treatment of an intertrochanteric femur fracture at our institution between 1976. We present a case of avn of the femoral head following fixation of a stable 2part intertrochanteric fracture in spite of good healing at the hip fracture site. Fractures of the trochanteric region in children and young. The bone healing is observed in all the cases in the mean period of 14. What the orthopedic surgeon wants to know1 each year, more than 250,000 hip fractures occur in the united states, resulting in considerable patient mortality and morbidity. Case report open access combined bilateral femoral head. Greater and lesser trochanter fractures are rare and have good prognosis.
This serious complication is possible in young patients. Mri of seemingly isolated greater trochanteric fractures. Avascular necrosis and subsequent femoral neck fracture 3. Avascular necrosis femoral neck fracture traumatology imaging techniques hip avn.
Ipsilateral concomitant displaced vertical femoral neck. The incidence of ipsilateral neckshaft fracture ranges from 2. Recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Pdf ipsilateral femoral neck and trochanter fracture.
Total hip arthroplasty is considered as a salvage procedure for older patients, patients with poor bone stock, avascular necrosis of the femoral head, associated with damaged acetabular articular cartilage 7. The greater trochanter is most vulnerable at its tip and upper portion, but its fracture. Aug 30, 2019 fractures can occur anywhere within these 4 regions. Greater trochanteric bursitis lumbar spine pathology. This study aims to under stand the technical difficulties which are the main prob lem in using these nails and finding a solution to these problems. Pelvis ctscan was performed and showed a bifocal fracture of the hip associating a nondisplaced inter trochanteric fracture and a nondisplaced capital fracture fig. Treatment of recent trochanteric fracture in adults. The incidence of femoral head fracture dislocation is between 826%. Norian srs trochanteric fractures in combination with dhs. Treatment of nonunion, femoral neck fracture and trochanteric fractures of the proximal femur with head involvement, unmanageable using other techniques. The system consists of a proximal femur plate, a distal femur plate, a curved femur shaft plate and a trochanter plate. Higher incidence of avascular necrosis, nonunion, malunion, and. Despite high union rates, the functional outcomes still tend to be disappointing. The es trochanteric nail is intended for the treatment of basilar neck, inter and high subtrochanteric femoral fractures.
The causal relationship between anfh and tfx remains controversial. These fractures have different characteristics, compared with the trochanteric fractures reported in earlier series. The entry failure, femoral shaft fracture, and reoperation is portal of the proximal femoral nail through the high 12%. Ho and avn have been identified as posttraumatic complications of femoral head fractures and may lead to a restriction in hip function and permanent disability 1, 49, 11, 16, 17. Tables concomitant displaced vertical neck fracture and unstable 4part trochanteric fracture in the ipsilateral femur has 00 references 10 received. Case study unstable 3part trochanteric fracture immediately postoperative. Patients with hip fractures have pain in the groin and are unable to bear weight.
Truly irreducible fracture dislocations must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Because of their purported rarity, greater trochanteric fractures have been included only incidentally, if at all, in most conventional hip fracture classifications 619. Magnetic resonance imaging, a ct scan, or a bone scan may occasionally be required to make the diagnosis. Nonaccidental trauma rare cause of hip fractures in children less than 12. Regardless of the preference of using a short nail or a long nail, a large percentage of the hip fractures encompass basilar neck, intertrochanteric or. However fractures occurring between the greater and lesser trochanters, called intertrochanteric fractures do require surgery, as do fractures occurring below the trochanters known as subtrochanteric fractures. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. Early prediction of femoral head avascular necrosis. Avascular necrosis and related complications following healed. M sliding hip screw versus im nail in reverse oblique trochanteric and subtrochanteric fractures. Current concepts on osteonecrosis of the femoral head.
Subcapital fracture with avascular necrosis of the whole. Fractures of type 33a extraarticular, supracondylar and fractures of type 33c fully articular fractures contraindications dcs pertrochanteric fractures or trochanteric fractures with subtrochanteric expansion 31a3. The clinical and radiological features appear to be similar to those of idiopathic avascular necrosis of the femoral head. The greater trochanter is most vulnerable at its tip and upper portion, but its fracture mechanisms have been debated 10, 14, 15. Norian srs injected into the posteromedial calcar region to strengthen the buttress.
Oct 24, 2020 for femoral fractures of the trochanteric region in children and adolescents, only two mechanisms have been identified to cause a fracture of the proximal femur. Avascular necrosis of the femoral head following trochanteric. Trochanteric nonunion may also increase the risk of prosthesis dislocation 2. Intertrochanteric fractures with a proximal fracture line appeared in five patients. Most of hip fractures occur in the elderly and are associated to a. Causes of hip pain less common things avascular necrosis femoralacetabular impingement labral tears. Gadegone1, bhaskaran shivashankar2, vijayanad lokhande3, and yogesh salphale3 1 department of orthopaedic and traumatology, associate professor of orthopaedics, gmc, 442402 chandrapur, maharashtra, india 2 iyer orthopaedic centre, 103, railway lines, 401 solapur, maharashtra, india. Avascular necrosis the femoral head presenting trochanteric. An analysis of the literature reveals that avulsion fractures of the greater trochanter are a rare injury among the paediatric population, but it may frequently lead to subsequent development of avascular necrosis of the femoral head15. Casereports patient 1 a23yearold blackwomanwithsystemiclupus erythematosus presentedona routine visit with a complaint of pain in the left buttock and lateral thigh. Avascular necrosis and related complications following healed osteoporotic intertrochanteric fractures. Clampassisted reduction of high sub trochanteric fractures of the femur. Request pdf avascular necrosis of the femoral head following trochanteric fractures in adults. An urgent reduction is required in traumatic hip dislocations to reduce the risk.
Treatment of unstable trochanteric fractures the balance. Hip joint motion was measured using a goniometer and compared to the healthy side. Proximal femoral nail in reverse trochanteric femoral. Discussion the surgical treatment for pipkin fractures remains a source of controversy, especially regarding the best surgical approach 1, 9, 12. It is unclear whether the incidence of nonunion and avascular necrosis avn of the femoral head in this type of fracture is greater than for reported intertrochanteric fractures in general. Two techniques for unstable intertrochanteric femoral fracture. Augmentation of proximal femoral nail in unstable trochanteric fractures wasudeo m. The incidence of avfh with a minimum of 1year followup was calculated 0. Femoral head fracture dislocations are rare, and irreducible cases are even less frequent. Avascular necrosis of the femoral head is an uncommon complication after intertrochanteric fractures. Revision of previously failed total hip arthroplasty. Introduction unstable intertrochanteric femoral fracture, such as comminuted fracture and wedge fracture. Although it can occur following fixation of unstable 3part or 4part.
Open reduction internal fixation orif with intra or extramedullary implants is the most frequent attitude in these fractures, which usually heal easily. Epidemiology 341k people visited eds with hip fractures 90% were 60y trochanteric. Femoral hip fractures are a common occurrence in the elderly. Comparative study trochanteric fracture treated with the proximal femoral nail antirotation and the third generation gamma nail. Most common pediatric hip fracture 40 50% result from severe trauma 7080% displaced at initial presentation initial displacement at time of injury best predictor of avn higher complication rate than type iii and iv avn reported up to 50% although thought to be less with more aggressive management. The mean age of our patients was 62 years range 25 93 yrs. Intertrochanteric fracture of the femur in an ankylosed hip scielo. The pathogenesis is unknown, but in patients developing pain who have had intertrochanteric fractures, osteonecrosis should be included in the differential diagnosis, especially in cases. Pdf short proximal femoral nail fixation for trochanteric.
Avn rate directly related to amount of displacement at time of injury. Posttraumatic femur head necrosis following trochanter fracture. We identified 20 patients between 1993 and 2018 with a trochanteric fracture under the age of 18 12 males. Mattan y, dimant a, mosheiff r, peyser a, mendelson s, liebergall m. Greater trochanter apophyseal avulsion in the adolescent. The nail tip was situated in every quadrant of the femoral head. Subcapital fracture with avascular necrosis of the whole femoral head after fixation of an intertrochanteric fracture.
Natsuko fukuoka department of orthopaedic surgery, kagawa university faculty of medicine, 17501 ikenobe, mikicho, kitagun, kagawa 7610793, japan. The role of trochanteric flip osteotomy in fixation of. Complications included iatrogenic fractures, varus malalignment, and comminution at the fracture site. Fracture of the greater trochanter during hip replacement. A hip fracture is a break that occurs in the upper part of the femur thigh bone. To determine factors that may influence the appearance of avascular necrosis after intertrochanteric fractures. The pipkin classification is commonly used to classify femoral head fractures. After reduction, the neurovascular examination remained normal. Pediatric hip fractures pediatric hip fractures pediatric hip. Key words stem type prosthesis of greater trochanter of the femur, proximal femoral nail antirotation, intertrochanteric femoral, unstable fracture, bone healing. The purpose of this traditional 510k is to expand the existing.
Jun 01, 2017 there were no cases of avascular necrosis avn at the end of the followup period of 1 year. Impact of surgical approach on postoperative heterotopic. Avascular necrosis of the femoral head anfh following trochanteric fractures tfx is infrequent. Specifically, it is not clear whether trochanteric nonunion or long term trochanteric pain is consequences of such fractures.
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