Sharma N, Bache E, Clare T
Department of Orthopedics, Royal Stoke Hospital, University hospital of North Midlands. UK. /
Department of Orthopedics, Royal Orthopedic Hospital. UK. /
J Orthop Case Rep. 2015 Jul-Sep;5(3):66-8. doi: 10.13107/jocr.2250-0685.312.
We report a case of an adolescent sustaining bilateral femoral neck fractures due to a first time epileptic seizure, as a result of expansion of his known syrinx.
A 19-year-old patient suffering from hypophosphatasia (HPP), Arnold-Chiari malformation, and a ventriculoperitoneal shunt sustained a trivial fall with profound pain and an inability to mobilize. Radiographs demonstrated a right-sided Garden-4 femoral neck and left-sided multi-fragmentary intracapsular/extracapsular fractures. The patient had previously suffered bilateral proximal femoral shaft fractures, treated with intramedullary unlocked nail fixation that was still in situ. Operative treatment with an exchange to Synthes Adolescent Lateral Recon nail was performed on the right with two Recon screws inserted into the femoral head. On the left, the existing Pedinail was preserved with an additional single screw inserted into the femoral head. In addition, 3 months of non-mobilization was required for adequate bone healing. After 1-year from time of injury, there is no avascular necrosis on radiographs and the patient is mobilizing pain-free.
Patients with hypophosphatasia have delayed bone healing. We recommend surgical fixation with an intramedullary device and periods of non-mobilization until there is radiographical evidence of adequate bone healing.
我们报告一例青少年因已知的脊髓空洞症扩大导致首次癫痫发作而发生双侧股骨颈骨折的病例。
一名19岁患者患有低磷酸酯酶症（HPP）、阿诺德-奇亚里畸形和脑室腹腔分流术，因轻微跌倒后出现剧痛且无法活动。X线片显示右侧为Garden-4型股骨颈骨折，左侧为多段囊内/囊外骨折。该患者此前曾发生双侧股骨近端骨干骨折，采用未锁定髓内钉固定，目前仍在位。右侧采用Synthes青少年外侧重建钉进行手术治疗，并在股骨头内插入两枚重建螺钉。左侧保留现有的Pedinail钉，并在股骨头内额外插入一枚螺钉。此外，需要3个月的制动以促进充分的骨愈合。受伤1年后，X线片显示无缺血性坏死，患者可无痛活动。
低磷酸酯酶症患者骨愈合延迟。我们建议采用髓内装置进行手术固定，并进行一段时间的制动，直至有X线证据表明骨已充分愈合。
