Shabat S, Mann G, Barchilon V, Kish B, Fredman B, Gepstein R, Nyska M
Department of Orthopaedic Surgery, The Sapir Medical Center, Kfar-Saba, and Tel-Aviv Sourasky Facult.
Hip Int. 2002 Jan-Mar;12(1):43-46. doi: 10.1177/112070000201200107.
We report a case of an unusual hip fracture that involved the intracapsular area and continued vertically to the extracapsular region below the trochanteric line. The division between these two types of fractures is based on the anatomical site, the blood supply and the mechanical forces that act on the hip. This division is important and influences the different surgical techniques to treat these individual fractures. Femoral neck fractures (intracapsular), particularly those with displacement, can disrupt the blood supply to the femoral head and may be associated with an increased incidence of complications, especially non-union and avascular necrosis (AVN) of the femoral head. These fractures are usually treated either by reduction and fixation, or by hemiarthroplasty. Non-union and avascular necrosis following extracapsular fractures are rare. Treatment involves reduction of the fracture and insertion of a dynamic hip screw. The combination of these two types of fractures is extremely rare and creates a surgical problem without any optimal solution. The focus of this case report is placed on the mechanical axis and weight-bearing forces that play a role in the hip and on the optional surgical techniques in such a rare type of fracture in an elderly osteoporotic patient. (Hip International 2002; 1: 43-6).
我们报告了一例罕见的髋部骨折病例，该骨折累及囊内区域并垂直延伸至转子线下的囊外区域。这两种骨折类型的划分基于解剖部位、血液供应以及作用于髋部的机械力。这种划分很重要，并且会影响治疗这些不同骨折的手术技术。股骨颈骨折（囊内骨折），尤其是那些有移位的骨折，会破坏股骨头的血液供应，并且可能与并发症发生率增加有关，特别是股骨头不愈合和缺血性坏死（AVN）。这些骨折通常通过复位固定或半髋关节置换术进行治疗。囊外骨折后出现不愈合和缺血性坏死的情况很少见。治疗方法包括骨折复位和动力髋螺钉置入。这两种骨折类型的组合极为罕见，会造成一个没有最佳解决方案的手术难题。本病例报告的重点在于髋部中起作用的机械轴和负重力量，以及针对老年骨质疏松患者这种罕见骨折类型的可选手术技术。（《国际髋部》2002年；1：43 - 6）
