![]() ![]() Due to the segmental nature of the fracture and the pre-existing severe arthritis, fixation was not considered a valid option, and the patient underwent a total hip replacement with plate stabilisation for the fracture extension (Fig. Following radiographs, a computerized tomography (CT) scan was performed to better define the fracture configuration and demonstrated fracture comminution. He was mobilising unaided and still managing to go to the shops.Īnterio-posterior pelvic radiograph of Case 1 following the fall (a).Īnd after total hip replacement and insertion of trochanteric grip plate (b).Ĭase 2: An 82 year old independent male with a history of hip osteoarthritis had a simple mechanical fall sustaining an intracapsular fracture with concominant subtrochanteric fracture (Fig. At final follow-up at 18 months he was pleased with the results of surgery and his radiographs were satisfactory. ![]() To address these factors, the patient underwent a complex primary total hip replacement with a constrained liner and trochanteric grip plate (Fig. ![]() The complicating factors were the patient’s cognitive impairment and abductor insufficiency secondary to the trochanteric fracture. In view of this, a decision was made to perform an arthroplasty. The patient had a high risk of fixation failure in view of his age, associated risk factors, and fracture configuration. The patient on radiographs had a displaced intracapsular and intertrochanteric fracture (Fig. Although he resided in a home, prior to the fall he enjoyed a degree of independence and regularly walked to the shops. He was a residential home resident with a history of previous alcoholism and cognitive impairment. Following a description of our cases we review the literature and make recommendations on the management of these challenging fractures.Ĭase 1: A 66 year old male sustained a low energy fall. This is the first report of the management of these fractures with total hip replacements. One total hip replacement included a constrained hip liner system. In our series, two patients received complex primary uncemented total hip replacements and the third patient received a Wagner modular, taper-fluted titanium stem with a bipolar head (Zimmer). We present three cases with segmental neck of femur fractures successfully managed with total hip replacements and a hemiarthroplasty. ![]()
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