Nishi Masanori, Yoshikawa Yasushi, Kaji Yasutaka, Okano Ichiro, Inagaki Katsunori
Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan.
Am J Case Rep. 2020 Dec 29;21:e927776. doi: 10.12659/AJCR.927776.
BACKGROUND The indication of total hip arthroplasty (THA) has been increasing among older and more frail patients who possibly have suboptimal bone quality. Pelvic insufficiency fractures (PIF) are rarely observed after THA. The appropriate diagnosis of fracture location is crucial, but its symptoms are non-specific and radiographic abnormality is often subtle; thus, diagnosis can be challenging, particularly in case of concomitant fractures at multiple locations. CASE REPORT A 47-year-old woman with rheumatoid arthritis and ongoing long-term oral corticosteroid therapy had groin pain in her left hip, which gradually developed without traumatic events 2.5 years after THA. Follow-up radiographs revealed an ipsilateral inferior pubic ramus fracture and a contralateral ischium fracture. The acetabular component of THA was slightly shifted upward, but further diagnostic examination was not conducted at that time. The pain was improved temporarily, but subsequently worsened and made her return to the clinic 6 months later, and radiographs revealed a medial wall fracture and superomedial migration of the acetabular component. She required a 2-stage revision procedure with massive allograft. At 1 year after these procedures, the patient is able to walk without a walking aid and does not report groin pain or present signs of dislocation, and radiographs show no loosening of the implant. CONCLUSIONS This case highlights that medial wall post-THA PIF can occur along with pubic/ischial fractures, which mask the symptoms of the medial wall fracture. We also reviewed the current literature and discussed the diagnostic strategy to be applied when suspecting this rare injury.
在年龄较大且身体较为虚弱、骨质可能欠佳的患者中，全髋关节置换术（THA）的适应证一直在增加。THA后很少观察到骨盆不全骨折（PIF）。准确诊断骨折部位至关重要，但其症状不具特异性，影像学异常往往不明显；因此，诊断可能具有挑战性，尤其是在多处同时发生骨折的情况下。病例报告：一名47岁患有类风湿关节炎且正在接受长期口服糖皮质激素治疗的女性，在THA术后2.5年，无外伤史，逐渐出现左髋部腹股沟区疼痛。随访X线片显示同侧耻骨下支骨折和对侧坐骨骨折。THA的髋臼组件略有向上移位，但当时未进行进一步的诊断检查。疼痛暂时有所改善，但随后加重，6个月后她再次回到诊所，X线片显示髋臼组件内侧壁骨折并向中上移位。她需要进行两阶段翻修手术，并植入大量同种异体骨。在这些手术后1年，患者能够在无需辅助行走器具的情况下行走，未报告腹股沟区疼痛或出现脱位迹象，X线片显示植入物无松动。结论：该病例突出表明，THA术后内侧壁PIF可能与耻骨/坐骨骨折同时发生，从而掩盖内侧壁骨折的症状。我们还回顾了当前的文献，并讨论了怀疑这种罕见损伤时应采用的诊断策略。
