Cases reported "Hip Fractures"

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1/50. Insufficiency fracture of the femoral neck after intramedullary nailing.

    We report a patient with insufficiency fracture that occurred after intramedullary nailing for a subtrochanteric fracture. Intramedullary nailing is speculated to have increased the stress in the already osteoporotic subcapital region. It therefore should be recognized as a causative factor in insufficiency fracture of the femoral neck. Careful follow-up is needed for patients with this condition.
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2/50. Subcapital femoral neck fracture after closed reduction and internal fixation of an intertrochanteric hip fracture: a case report and review of the literature.

    A subcapital femoral neck fracture in a healed intertrochanteric fracture treated by an open reduction and internal fixation is a rare, but catastrophic, event. We present the case of an 86-year-old woman, a community ambulator, who sustained a displaced right intertrochanteric hip fracture during a fall. She was treated with closed reduction and internal fixation with a dynamic compression hip screw and side plate. Four months later, she was noted to have a displaced subcapital femoral neck fracture and underwent hip screw and side plate hardware removal and cemented bipolar hemiarthroplasty. Both postoperative recoveries were uncomplicated, and she was discharged to a rehabilitation facility able to ambulate with minimal assistance. This devastating complication in patients with osteoporosis may be prevented by deeper placement of the dynamic hip compression lag screw to within 5 mm to 8 mm of the subchondral bone, which may decrease the stress forces in the subcapital femoral neck.
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3/50. fatigue failure of an AO spiral blade.

    We report an unusual case of a femoral neck stress fracture leading to the fatigue failure of an AO spiral blade. An unreamed femoral nail with a spiral blade was inserted to treat an unstable subtrochanteric femoral fracture. which lead to fracture union at 5 months. Eight months post-operatively the patient started to complain of left hip pain. Serial radiographs revealed progressive osteoporosis of the proximal femur possibly due to the stress sharing effect of a stiff intramedullary device, which continued to bear a significant amount of the transmitted load. The cause of pain was a stress fracture of the femoral neck and the AO spiral blade, which only became radiologically visible 4 months after the start of the symptoms (1 year after the initial operation). The implant was removed and replaced by a cemented hemiarthroplasty. This case reaffirms the difficulty in diagnosing a stress fracture through a metallic implant. The delay in diagnosis may be shortened if stress fracture were included as an expected complication following an intramedullary nailing.
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4/50. Concomitant fractures of the femoral head and neck without hip dislocation.

    This case report describes two patients who sustained ipsilateral fractures of the femoral head and femoral neck without dislocation of the hip. The fractures in the two patients resulted from vehicle accidents. The femoral head was fractured in the sagittal plane, and the femoral neck was fractured at the subcapital portion. However, the hip was not dislocated in either patient. Both patients were treated using cementless total hip arthroplasty. These unusual hip injuries have not been reported previously and are not categorized according to any known classification system of hip injuries.
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5/50. Spontaneous femoral neck fracture complicating a healed subtrochanteric fracture--a case report.

    A rare case of spontaneous femoral neck fracture complicating a healed subtrochanteric fracture was encountered in an 85-year-old female. The subtrochanteric fracture was caused by a minor trauma with no other combined injury. Patient received close reduction and internal fixation two days later and the fracture healed in three months. Six months after operation, spontaneous ispilateral femoral neck fracture occurred without trauma. Although there were some reports about subcapital fracture or femur neck fracture complication after operation, this is the first case of spontaneous femoral neck fracture after healed subtrochanteric fracture which was treated with a 95 degrees dynamic condylar screw (DCS) and side plate previously without technical error.
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6/50. Subtrochanteric fracture after cannulated screw fixation of femoral neck fractures: a report of four cases.

    Subtrochanteric fractures after screw or pin fixation of femoral neck fractures are a recognized complication. No literature is available on this complication after fixation using the recently popularized cannulated screws. We present our experience in treating four of these complications. The common denominator for all four patients seemed to be an entry point in the lateral cortex below the level of the most inferior edge of the lesser trochanter.
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7/50. Decreased cutaneous vitamin d-synthesis in heavily melanized individuals: a rare cause for pathologic fractures of the hip.

    Painful pathological fractures of the femoral neck and the subtrochanteric region of the femur are reported in two women originating from india. After exclusion of renal or intestinal causes, laboratory data on bone metabolism, scintigraphic and radiographic examinations were characteristic for the presence of secondary hyperparathyroidism. Based on vitamin deficiency and low calcium absorption, disturbed mineralization of bone and increased osteoclastic resorption have apparently led to osteomalacia and subsequent fracturing. Fracture localization necessitated surgical fixation in one patient; conservative treatment including protected weightbearing was effective in the other women. After supplementation of calcium and vitamin D3, levels of parathyroid hormone and scintigraphic alterations returned to normal in both patients. In these two cases, pathological fractures of the hip could be attributed to the presence of secondary hyperparathyroidism based on decreased cutaneous vitamin d synthesis.
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8/50. Fracture of the lesser trochanter.

    Isolated fracture or detachment of the lesser trochanter is an infrequent occurrence. In most cases the event is part of a complex of fractures involving the femoral neck and the greater trochanter. Isolated fracture caused by direct trauma is rare because of the anatomical location of the lesser trochanter which is protected anteriorly and posteriorly by large muscular masses, superiorly by the head and the neck of the femur, laterally by the femur itself, and medially by the ilio- and ischio-public branches of the pelvis. Trauma is usually indirect, caused by sudden traction by the iliopsoas muscle on the femoral tendinous insertion. The highest frequency is observed in young patients who are still growing where there is an imbalance between muscular strength and resistance of the osteochondral plate of the tendinous insertion. Particularly affected are adolescent athletes of male sex aged from 13 to 17 years. Similar overloading of traction in an adult would probably produce only muscular stretching. diagnosis is based on radiographic ascertainment, obtained with the thigh in extra-rotation, supported by rather typical clinical findings such as acute pain in the inguinal region and in Scarpa's triangle, limping, passive movement of the hip in all directions with pain in maximum extension and relief when seated. Nonsurgical treatment with the limb resting in flexion, further confirmed by the case presented in this study, still remains the treatment of choice in most cases, obtaining excellent functional results. The authors believe that it was of interest to report this clinical case because of the rareness of the pathology observed and because of the specific features of its etiology.
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9/50. Open traumatic posterior dislocation of the hip. A case report.

    A case of open traumatic posterior dislocation of the hip is presented. The femoral head and neck were completely out of the skin and there were accompanying fractures of the acetabular floor, the ischial ramus and the greater trochanter. To our knowledge, such a case has not been reported previously and this, together with its interesting mechanism, has led us to report the case. It was followed for 18 months and roentgenographic and 99mtechnetium sulphur colloid scanning studies showed avascular necrosis and osteoarthritis.
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10/50. Late presentation of a displaced subcapital fracture of the hip in transient osteoporosis of pregnancy.

    Transient osteoporosis of the hip is rare and has two demographic peaks, one during the third trimester of pregnancy and the other around the fifth to sixth decade of life. During pregnancy, osteoporosis presents with insidious onset of hip pain and antalgic limp with no antecedent infection or trauma. Radiographs show pronounced osteopenia of the femoral head and neck with preservation of the joint space. 1 Bone scan and magnetic resonance imaging are sensitive but not specific for diagnosis, and laboratory studies are typically normal. 2 We present the case of a patient with a displaced, grossly unstable subcapital hip fracture who presented 5 months postpartum and describe successful treatment by open reduction and internal fixation with a muscle-pedicle bone graft.
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