Lee Sang Yang, Niikura Takahiro, Iwakura Takashi, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
BMJ Case Rep. 2014 Jul 11;2014:bcr2014205161. doi: 10.1136/bcr-2014-205161.
An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture.
一名82岁女性跌倒后发生左股骨转子间骨折。采用股骨近端抗旋髓内钉（PFNA）II进行骨折固定，3个月后她能够借助丁字拐行走。术后11个月，患者跌倒后出现左髋部疼痛。X线片显示刀片尖端上方的股骨头软骨下塌陷。作者取出PFNA-II，随后进行了骨水泥型双极半髋关节置换术。股骨头的组织学评估显示骨质疏松，无骨坏死迹象。在塌陷的软骨下区域可见修复组织、肉芽组织和骨痂形成。基于这些发现，诊断为愈合的转子间骨折后发生的创伤性股骨头软骨下骨折。转子间骨折内固定后，可能需要考虑创伤性股骨头软骨下骨折这一诊断。
