Combined Bipolar Hemiarthroplasty with Lateral Plate and Cable Fixation in Ipsilateral Femoral Neck and Subtrochanteric Fracture: A Case Report
Dary Gunawan *
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
IGN Wien Aryana
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Femoral neck following with subtrochanteric fracture still rare and challenging to manage. In elderly, this injury related with low energy trauma due to the low bone density. With significant complications such as vascular necrosis, non-union and malunion, potentially greater than those associated with single fractures. However, reviews regarding the treatment of this fracture pattern are still limited.
Case Presentation: 83 years old female present with ipsilateral femoral neck and subtrochanteric fracture after slipped at her home without any history of trauma. From physical examination patient presented with shortening and external rotation of right lower extremity. Patient was planned for bipolar hemiarthroplasty using long stem cemented and open reduction with internal fixation of plate screws and wiring and early mobilization after surgery with non-weight bearing mobilization for 3 months. On follow-up, patient was found with improvement in subtrochanteric abductor insufficiency and functional outcome of Harris Hip Score.
Discussion: Concomitant ipsilateral femoral neck and subtrochanteric fracture is a rare injury pattern. It's particularly frequent in osteoporotic people who have low energy falls. Close study of radiographs is thus required to ensure that more minor fractures are not discovered and that the injury is handled properly. Primary open reduction and internal fixation with the prosthesis left in place is the most acceptable method for keeping the stem securely secured. To accomplish firm fixation, plate fixation must include proximal cable connection points and distal screws. Early mobilization was found beneficial in improving functional outcomes.
Conclusion: Arthroplasty and osteosynthesis with plate and wire fixation in simultaneous ipsilateral femoral neck and subtrochanteric fractures in the elderly can result in good clinical results when combined with early mobilization. Additional research with bigger cohorts is required to validate and enhance current treatment techniques.
Keywords: Femoral neck fracture, subtrochanteric fracture, hemiarthroplasty bipolar, plate and screw wire fixation