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股骨颈囊内移位骨折畸形愈合:1例罕见病例。

Malunion in displaced intracapsular fracture of femoral neck: A rare case.

作者信息

Verma Nikhil, Singh M P, Ul Haq Rehan, Aggarwal Aditya N, Jain Anuj

机构信息

Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, New Delhi 110085, India.

出版信息

Chin J Traumatol. 2015;18(5):307-10. doi: 10.1016/j.cjtee.2015.05.003.

Abstract

Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and cannulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane (coxa valga or coxa vara). We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side (Garden type 4 and Pauwel type 3). The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the radiographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture.

摘要

股骨颈囊内骨折采用解剖复位(最好是闭合复位)和空心松质拉力螺钉固定治疗。这些骨折的畸形愈合已在冠状面有所描述(髋外翻或髋内翻)。我们报告了一例年轻成年患者,其股骨颈囊内移位骨折在矢状面畸形愈合并伴有骨痂形成,功能结果良好。X线片显示右侧股骨颈囊内骨折(Garden 4型和Pauwel 3型)。患者接受手术,进行了闭合复位并用三根空心松质螺钉进行内固定。术后X线片在侧位片上显示复位丢失。由于这一技术失误,建议患者进行翻修固定,但患者拒绝。9个月时,我们观察到骨折在移位位置通过骨痂形成实现愈合。2年时Harris髋关节评分96分,表明功能结果良好,X线片未显示股骨头缺血性坏死的任何证据。我们建议患者进行翻修手术,因为其植入物失败和不愈合的几率增加。然而,他拒绝了翻修手术,继续维持欠佳的复位状态。然而,骨折愈合了,而且是通过骨痂形成愈合的,这在股骨颈骨折中并非常见现象。

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