Yoon Byung-Ho, Park Sung Bae
Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea.
Department of Orthopaedic Surgery, KEPCO Medical Foundation, KEPCO Medical Center, Seoul, South Korea.
JBJS Case Connect. 2017 Jan-Mar;7(1):e1. doi: 10.2106/JBJS.CC.16.00006.
We present a rare case of insufficiency fracture at the level of the distal interlocking screw following union of an intertrochanteric hip fracture. A 74-year-old woman reported chronic thigh pain for 1 month. She had a history of an osteoporotic stable intertrochanteric fracture that was successfully treated with a short intramedullary nail 3.5 years prior. However, after union, the neck-shaft angle of the femur changed from 125° to 117°. She had been on alendronic acid therapy to prevent a secondary osteoporotic fracture. A recent radiograph and bone scan suggested an insufficiency fracture around the level of the distal interlocking screw. Revision surgery with a long intramedullary nail was performed, and complete union was observed 1 year postoperatively.
This case suggests that subsequent insufficiency fracture can occur after complete union of an intertrochanteric hip fracture. Physicians should be aware of the possibility of a stress fracture when a patient has thigh pain after an intertrochanteric fracture has healed following repair with a short intramedullary nail.
我们报告一例罕见的股骨粗隆间骨折愈合后，远端交锁螺钉处发生的应力性骨折。一名74岁女性，自述大腿慢性疼痛1个月。她有骨质疏松性稳定型股骨粗隆间骨折病史，3.5年前成功接受了短髓内钉治疗。然而，骨折愈合后，股骨颈干角从125°变为117°。她一直在接受阿仑膦酸治疗以预防继发性骨质疏松性骨折。近期的X线片和骨扫描提示远端交锁螺钉水平周围存在应力性骨折。遂行长髓内钉翻修手术，术后1年观察到骨折完全愈合。
该病例提示，股骨粗隆间骨折完全愈合后可能发生继发性应力性骨折。医生应意识到，当患者在接受短髓内钉修复的股骨粗隆间骨折愈合后出现大腿疼痛时，存在发生应力性骨折的可能性。
